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Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes.
Am J Kidney Dis. 2003 Jan; 41(1):13-21.AJ

Abstract

BACKGROUND

Increased urine albumin excretion (UAE) predicts nephropathy progression in type 2 diabetes, whereas improved blood pressure (BP) control and angiotensin-converting enzyme (ACE) inhibition ameliorate both albuminuria and nephropathy progression. Cigarette smoking (CS) predicts nephropathy progression in patients with type 2 diabetes despite improved BP control and ACE inhibition. We tested the hypothesis that CS and increased UAE are interrelated predictors of nephropathy progression in patients with type 2 diabetes undergoing improved BP control and ACE inhibition.

METHODS

We prospectively followed plasma creatinine (P(cr)) levels and UAE as albumin-creatinine (alb-cr) ratio for 63.9 +/- 0.6 months in 84 patients with type 2 diabetes undergoing BP control with regimens including ACE inhibitors.

RESULTS

Despite ACE inhibition and mean BP reduction from 113.7 +/- 1.8 to 92.3 +/- 0.6 mm Hg (P < 0.001), P(cr) increased (1.03 +/- 0.02 to 1.25 +/- 0.04 mg/dL [91.1 +/- 1.8 to 110.5 +/- 3.5 micromol/L]; P < 0.001) during follow-up. Regression analysis showed that entry alb-cr ratio, but not CS, predicted nephropathy progression when considering both factors together, but CS predicted progression only when excluding alb-cr ratio. Nephropathy progression was minimal for lower levels of alb-cr ratio at entry, but increased progressively for levels greater than 300. Alb-cr ratio increment during follow-up directly correlated with nephropathy progression (r2 = 0.307; P < 0.001) and was greater in smokers than nonsmokers (1,878 +/- 346 versus 553 +/- 214; P < 0.001).

CONCLUSION

Data show that CS and increased UAE are interrelated predictors of nephropathy progression in patients with type 2 diabetes, and CS increases UAE in these patients despite improved BP control and ACE inhibition.

Authors+Show Affiliations

Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12500217

Citation

Chuahirun, Temduang, et al. "Cigarette Smoking and Increased Urine Albumin Excretion Are Interrelated Predictors of Nephropathy Progression in Type 2 Diabetes." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 41, no. 1, 2003, pp. 13-21.
Chuahirun T, Khanna A, Kimball K, et al. Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes. Am J Kidney Dis. 2003;41(1):13-21.
Chuahirun, T., Khanna, A., Kimball, K., & Wesson, D. E. (2003). Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 41(1), 13-21.
Chuahirun T, et al. Cigarette Smoking and Increased Urine Albumin Excretion Are Interrelated Predictors of Nephropathy Progression in Type 2 Diabetes. Am J Kidney Dis. 2003;41(1):13-21. PubMed PMID: 12500217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes. AU - Chuahirun,Temduang, AU - Khanna,Apurv, AU - Kimball,Kay, AU - Wesson,Donald E, PY - 2002/12/25/pubmed PY - 2003/1/18/medline PY - 2002/12/25/entrez SP - 13 EP - 21 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 41 IS - 1 N2 - BACKGROUND: Increased urine albumin excretion (UAE) predicts nephropathy progression in type 2 diabetes, whereas improved blood pressure (BP) control and angiotensin-converting enzyme (ACE) inhibition ameliorate both albuminuria and nephropathy progression. Cigarette smoking (CS) predicts nephropathy progression in patients with type 2 diabetes despite improved BP control and ACE inhibition. We tested the hypothesis that CS and increased UAE are interrelated predictors of nephropathy progression in patients with type 2 diabetes undergoing improved BP control and ACE inhibition. METHODS: We prospectively followed plasma creatinine (P(cr)) levels and UAE as albumin-creatinine (alb-cr) ratio for 63.9 +/- 0.6 months in 84 patients with type 2 diabetes undergoing BP control with regimens including ACE inhibitors. RESULTS: Despite ACE inhibition and mean BP reduction from 113.7 +/- 1.8 to 92.3 +/- 0.6 mm Hg (P < 0.001), P(cr) increased (1.03 +/- 0.02 to 1.25 +/- 0.04 mg/dL [91.1 +/- 1.8 to 110.5 +/- 3.5 micromol/L]; P < 0.001) during follow-up. Regression analysis showed that entry alb-cr ratio, but not CS, predicted nephropathy progression when considering both factors together, but CS predicted progression only when excluding alb-cr ratio. Nephropathy progression was minimal for lower levels of alb-cr ratio at entry, but increased progressively for levels greater than 300. Alb-cr ratio increment during follow-up directly correlated with nephropathy progression (r2 = 0.307; P < 0.001) and was greater in smokers than nonsmokers (1,878 +/- 346 versus 553 +/- 214; P < 0.001). CONCLUSION: Data show that CS and increased UAE are interrelated predictors of nephropathy progression in patients with type 2 diabetes, and CS increases UAE in these patients despite improved BP control and ACE inhibition. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/12500217/Cigarette_smoking_and_increased_urine_albumin_excretion_are_interrelated_predictors_of_nephropathy_progression_in_type_2_diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272638602691115 DB - PRIME DP - Unbound Medicine ER -