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Diabetes Care. 2003 Mar;26(3):911-6.

Smoking and progression of diabetic nephropathy in type 1 diabetes.

Author information

  • 1Steno Diabetes Center, Gentofte, Denmark. phovind@dadlnet.dk

Abstract

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 = 301) followed for at least 3 years, median (range) 7 years (3-14), who underwent at least yearly measurement of glomerular filtration rate (GFR) by the (51)Cr-EDTA plasma clearance technique (n = 8, range 3-24). In total, 192 men and 109 women were included (age [mean +/- SD] 36 +/- 11 years, duration of diabetes 22 +/- 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 (deltaGFR) was 4.0 (0.2) mlx min(-1) x year(-1) during the investigation period. No difference in Delta GFR was demonstrated between nonsmokers (n = 94), deltaGFR 4.5 (0.4), ex-smokers (n = 31), deltaGFR 3.1 (0.7), and smokers (n = 176), deltaGFR 3.9 (0.3) ml x min(-1) x year(-1), respectively (NS). Adjustment for other risk factors for progression of diabetic nephropathy did not alter the results: smoking was not associated with deltaGFR, 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.

PMID:
12610058
[PubMed - indexed for MEDLINE]
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