Smoking Is Associated With Progression of Diabetic Nephropathy

Sawicki, Peter T.; Didjurgeit, Ulrike; Mühlhauser, Ingrid; Bender, Ralf; Heinemann, Lutz; Berger, Michael

doi:10.2337/diacare.17.2.126

Cited by 256 publications

(150 citation statements)

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“…The progression can be delayed by antihypertensive therapy [30], and may be influenced by the quality of metabolic control [31] and protein intake [32]. Recently, an association K. S. L. Lain et al: CholesteroMowering therapy and diabetic nephropathy of smoking with the progression of diabetic nephropathy has also been suggested [33]. The findings of this small study are supportive of a pathogenetic role of hypercholesterolaemia in progressive diabetic glomerular disease.…”

Section: Discussionsupporting

confidence: 56%

Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

et al. 1995

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SummaryThere is experimental evidence to suggest that hypercholesterolaemia may play a pathogenetic role in progressive glomerular injury. We investigated the effect of cholesterol-lowering therapy on the progression of diabetic nephropathy in 34 patients with non-insulin-dependent diabetes mellitus. Patients were randomly assigned in a single-blind fashion to treatment with either lovastatin, an HMG CoA reductase inhibitor (n = 16; mean dose 30.0 + 12.6 mg/day) or placebo (n = 18) for 2 years. Renal function was assessed by serially measuring the serum creatinine, glomerular filtration rate (using CrSl-EDTA), and 24-h urinary protein excretion. Lovastatin treatment was associated with significant reductions in total cholesterol (p < 0.001), LDL-cholesterol (p < 0.001) and apo B (p < 0.01), the reductions at 24 months being 26, 30 and 18 %, respectively. Beneficial effects on serum triglyceride, HDL-cholesterol and apo AI levels were also observed. Lp(a) showed no significant change in both groups. Glomerular filtration rate deteriorated significantly in the placebo group after 24 months (p < 0.025) but showed no significant change in the lovastatin-treated patients. The increase in serum creatinine was statistically significant (p < 0.02) in placebo-treated patients at 12 and 24 months, and in the lovastatin group after 24 months. Twenty-four hour urinary protein excretion increased in both groups (p < 0.05). Lovastatin treatment was not associated with significant elevations in liver or muscle enzymes. We conclude that effective normalisation of hypercholesterolaemia may retard the progression of diabetic nephropathy. [Diabetologia (1995) 38: 604-609]

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Section: Discussionsupporting

confidence: 56%

Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

et al. 1995

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“…Previous studies showed that smoking is an important risk factor for progression of established diabetic nephropathy [32,33]. These findings suggest that the beneficial effect of not smoking is applicable to diabetic patients, especially those with nephropathy.…”

Section: Discussionmentioning

confidence: 82%

Predictors of the progression of diabetic nephropathy and the beneficial effect of angiotensin-converting enzyme inhibitors in NIDDM patients

et al. 1997

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“…The impact of cigarette smoking on decline in kidney function in overt diabetic nephropathy in type 1 diabetes has scarcely been studied. Sawicki et al (23) suggested that smoking worsens kidney function as measured by creatinine clearance in a 1-year study of 93 type 1 diabetic patients. However, blood pressure was higher in smokers than in nonsmokers at baseline (148/88 vs. 140/86 mmHg) as well as during follow-up (143/84 vs. 137/85 mmHg).…”

Section: Resultsmentioning

confidence: 99%

Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes

Hovind

Rossing²,

Tarnow³

et al. 2003

Diabetes Care

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OBJECTIVE -Cigarette smoking contributes to development of diabetic nephropathy. However, long-term studies on the effect of smoking on decline in kidney function in diabetic nephropathy are lacking. We assessed the impact of smoking on progression of diabetic nephropathy in type 1 diabetic patients enrolled in a prospective observational cohort study started in 1983.RESEARCH DESIGN AND METHODS -We identified all albuminuric type 1 diabetic patients (n ϭ 301) followed for at least 3 years, median (range) 7 years (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), who underwent at least yearly measurement of glomerular filtration rate (GFR) by the 51 Cr-EDTA plasma clearance technique (n ϭ 8, range 3-24). In total, 192 men and 109 women were included (age [mean Ϯ SD] 36 Ϯ 11 years, duration of diabetes 22 Ϯ 8 years); 271 patients were treated with antihypertensive drugs, predominantly ACE inhibitors in 179 patients. Patients were classified as smokers if they smoked more than one cigarette per day during a portion of or the entire observation period. Blood pressure, albuminuria, HbA 1c , and serum cholesterol were measured every 3-4 months during the study. RESULTS -In all 301 patients, the mean (SE) rate of decline in GFR (⌬GFR) was 4.0 (0.2) ml ⅐ min -1 ⅐ year -1 during the investigation period. No difference in ⌬GFR was demonstrated between nonsmokers (n ϭ 94), ⌬GFR 4.5 (0.4), ex-smokers (n ϭ 31), ⌬GFR 3.1 (0.7), and smokers (n ϭ 176), ⌬GFR 3.9 (0.3) ml ⅐ min -1 ⅐ year -1 , respectively (NS). Adjustment for other risk factors for progression of diabetic nephropathy did not alter the results: smoking was not associated with ⌬GFR, whereas blood pressure, albuminuria, HbA 1c , and serum cholesterol were demonstrated to be independent progression promoters.CONCLUSIONS -In our study, smoking was not associated with decline in kidney function in type 1 diabetic patients with diabetic nephropathy. Diabetes Care 26:911-916, 2003

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Smoking Is Associated With Progression of Diabetic Nephropathy

Abstract: Cigarette smoking represents an important factor associated with progression of nephropathy in treated hypertensive type I diabetic patients.

Cited by 256 publications

References 0 publications

Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

Cholesterol-lowering therapy may retard the progression of diabetic nephropathy

Predictors of the progression of diabetic nephropathy and the beneficial effect of angiotensin-converting enzyme inhibitors in NIDDM patients

Smoking and Progression of Diabetic Nephropathy in Type 1 Diabetes

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