Original InvestigationsCigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition☆,☆☆,★
Section snippets
Materials and methods
Patients eligible for this study were diabetics referred to the Texas Tech University Health Sciences Center (TTUHSC) nephrology clinic for evaluation and management of urine dipstick-positive proteinuria (≥1+). Study subjects were recruited in 1995 to be followed until the end of 2000. Patients were determined to have diabetes by their primary care physician and must have had at least one documented fasting blood glucose level greater than 126 mg/dL before beginning hypoglycemic therapy. All
Results
Table 1 shows initial patient characteristics and after 64.0 ± 1.1 months of follow-up.
Age (y) Sex (% M) Body Weight (kg) Ethnicity (% B/W/H) Systolic BP (mm Hg) Diastolic BP (mm Hg) Mean BP (mm Hg) Hemoglobin A1c (%) Plasma Albumin (mg/dL) Plasma Creatinine (mg/dL) Calculated GFR (mL/min) Smoke? (% Yes) Urine Protein-to-Creatinine Ratio Initial 45.5 ± 2.0 55 83.9 ± 2.0 24.2/30.3/45.5 145.1 ± 3.0 86.6 ± 2.1 106.1 ± 2.2 10.6 ± 0.9 3.6 ± 0.2 1.06 ± 0.03
Discussion
Patients with DN progress inexorably toward ESRD, albeit more slowly with improved BP and ACE inhibitor therapy.3, 4, 5, 6 We prospectively examined clinical factors that predict progression of type 2 DN in patients with initially well-preserved renal function and treated as currently recommended.2 Cigarette smoking was the only examined factor that predicted DN progression, and the rate in smokers was twice that of nonsmokers. These studies show that smoking is a risk factor for DN progression
Acknowledgements
We are thankful to Kay T. Kimball, PhD, and Ronald B. Harrist, PhD, for expert statistical analysis. We also thank the nursing and clerical staff of the Internal Medicine Clinic of the Department of Internal Medicine at Texas Tech University Health Sciences Center, for their valuable assistance.
References (30)
- et al.
Prevention of diabetic renal disease with special reference to microalbuminuria
Lancet
(1995) - et al.
Monogenic diabetes mellitus in youth: The MODY syndromes
Endocrinol Metab Clin North Am
(1999) - et al.
Reactive oxygen species enhances endothelin-1 production of diabetic rat glomeruli in vitro and in vivo
J Lab Clin Med
(2000) - et al.
Elevated endothelin-1 levels after cigarette smoking
Metabolism
(1994) - et al.
Smoking and oxidant stress: Assay of isoprostane in human urine by gas chromatography-mass spectrometry
J Chromatogr B Biomed Sci Appl
(2000) USRDS 2000 Annual Data Report
(2000)- et al.
Screening and management of microalbuminuria in patients with diabetes mellitus: Recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the Council on Diabetes Mellitus of the National Kidney Foundation
Am J Kidney Dis
(1995) - et al.
Long-term stabilizing effect of angiotensin converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients
Ann Intern Med
(1993) - et al.
Renal protective effects of enalapril in hypertensive NIDDM: Role of baseline albuminuria
Kidney Int
(1994) - et al.
Predictors of the progression of diabetic nephropathy and the beneficial effect of angiotensin converting enzyme inhibitors in NIDDM patients
Diabetologia
(1997)
The effects of dietary protein restriction and blood-pressure control on the progression chronic renal disease
N Engl J Med
Disparities in incidence of incidence of diabetic end-stage renal disease according to race and type of diabetes
N Engl J Med
Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy
Lancet
Projections of hypertension-related renal disease in middle-aged residents of the United States
JAMA
Cigarette smoking and the prevalence of microangiopathy in juvenile-onset insulin-dependent diabetes mellitus
Diabetes Care
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Supported by Texas Tech University Health Sciences Center.
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Address reprint requests to Donald E. Wesson, MD, Texas Tech University Health Sciences Center, 3601 Fourth Street, Lubbock, TX 79430. E-mail: [email protected]
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