Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition

Chuahirun, Temduang; Wesson, Donald E.

doi:10.1053/ajkd.2002.30559

Cited by 108 publications

(55 citation statements)

References 27 publications

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“…Statistical analysis showed that smoking is associated with significantly elevated risk of DN (OR=2.24, CI 95% 1.27-3.96, P= 0.005) [23], with the greatest risk of CKD development among heavy smokers (>30 pack years) as reflected with OR=2.6 (95% CI=1.53-4.41, p < 0.0001) [23]. These results are in line with earlier clinical studies suggesting smoking as a major exacerbating factor for DN progression in both type 1 [24][25][26] and type 2 diabetics [27,28]. However, this study is suggesting association rather than causation.…”

Section: Smokingsupporting

confidence: 87%

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

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AbstractDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Alarming recent data described diabetes as an unprecedented worldwide epidemic, with a prevalence of ∼6.4% of the world population in 2010, while the prevalence of CKD among diabetics was approximately 40%. With a clinical field hungry for novel markers predicting DN, several clinical and laboratory markers were identified lately with the promise of reliable DN prediction. Among those are age, gender, hypertension, smoking, sex hormones and anemia. In addition, eccentric left ventricular geometric patterns, detected by echocardiography, and renal hypertrophy, revealed by ultrasonography, are promising new markers predicting DN development. Serum and urinary markers are still invaluable elements, including serum uric acid, microalbuminuria, macroalbuminuria, urinary liver-type fatty acid-binding protein (u-LFABP), and urinary nephrin. Moreover, studies have illustrated a tight relationship between obstructive sleep apnea and the development of DN. The purpose of this review is to present the latest advances in identifying promising predictors to DN, which will help guide the future research questions in this field. Aiming at limiting this paramount threat, further efforts are necessary to identify and control independent modifiable risk factors, while developing an integrative algorithm for utilization in DN future screening programs.

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Section: Smokingsupporting

confidence: 87%

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

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“…A faster rate of GFR decline was independently associated with heavy smoking. Several smaller prospective studies have confirmed the deteriorating effect of smoking (31)(32)(33).…”

Section: Patients With Diabetesmentioning

confidence: 93%

Smoking

Orth

Hallan²

2008

Clinical Journal of the American Society of Nephrology

256

174

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Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.

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“…This is true even when patients are on ACE inhibitors and have achieved adequate BP control (83). Consequently, nephrologists should not remain passive, but constantly point out the adverse effects of smoking to their patients.…”

Section: Prevention Of the Onset Of Diabetic Nephropathymentioning

confidence: 99%