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Acta Diabetol. 2016 Aug;53(4):525-33. doi: 10.1007/s00592-015-0822-0. Epub 2015 Dec 14.

Smoking and progression of diabetic nephropathy in patients with type 1 diabetes.

Feodoroff M1,2,3, Harjutsalo V1,2,3,4, Forsblom C1,2,3, Thorn L1,2,3, Wadén J1,2,3, Tolonen N1,2,3, Lithovius R1,2,3, Groop PH5,6,7,8.

Author information

1
Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014, Helsinki, Finland.
2
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
3
Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
4
Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
5
Folkhälsan Research Center, Folkhälsan Institute of Genetics, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014, Helsinki, Finland. per-henrik.groop@helsinki.fi.
6
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. per-henrik.groop@helsinki.fi.
7
Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi.
8
The Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia. per-henrik.groop@helsinki.fi.

Abstract

AIMS:

To evaluate the effect of cumulative smoking on the development of diabetic nephropathy.

METHODS:

Study included 3613 patients with type 1 diabetes, participating in the Finnish Diabetic Nephropathy Study. The 12-year cumulative risk of microalbuminuria, macroalbuminuria and end-stage renal disease (ESRD) was estimated for current, ex- and nonsmokers. Cox regression analyses, with multivariable adjustments for other risk factors for diabetic nephropathy, were used to evaluate the risk at different stages of diabetic nephropathy based on the cumulative amount of smoking in pack-years.

RESULTS:

The 12-year cumulative risk of microalbuminuria was 18.9 % (95 % CI 14.6-23.0, P < 0.0001) for current smokers and 15.1 % (10.3-19.6, P = 0.087) for ex-smokers, compared with 10.0 % (7.8-12.1) for nonsmokers. The corresponding risks of macroalbuminuria were 14.4 % (95 % CI 10.8-17.9, P < 0.0001), 6.1 % (3.5-8.6, P = 0.082) and 4.7 % (3.0-6.4), respectively. The 12-year cumulative risk of ESRD was 10.3 % (95 % CI 8.4-12.4, P < 0.0001) for current smokers and 10.0 % (7.9-12.3, P < 0.0001) for ex-smokers, compared with 5.6 % (4.6-6.7) for nonsmokers. In the current smokers, one pack-year increased the risk of macroalbuminuria with a HR of 1.025 (1.010-1.041) and the risk of ESRD with a HR of 1.014 (1.001-1.026) compared with nonsmokers, in the fully adjusted model. In the ex-smokers, the risk of macroalbuminuria and ESRD was no different from the risk in nonsmokers after multivariable adjustment.

CONCLUSIONS:

Current smoking is a risk factor for the progression of diabetic nephropathy and the risk increases with the increasing dose of smoking. Ex-smokers seem to carry a similar risk of progression of diabetic nephropathy as nonsmokers.

KEYWORDS:

Diabetic nephropathy; End-stage renal disease; Macroalbuminuria; Microalbuminuria; Smoking; Smoking cessation; Type 1 diabetes

PMID:
26668013
DOI:
10.1007/s00592-015-0822-0
[Indexed for MEDLINE]

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