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: 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.
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Authors | Temduang Chuahirun, Apurv Khanna, Kay Kimball, Donald E Wesson |
Journal | American journal of kidney diseases : the official journal of the National Kidney Foundation
(Am J Kidney Dis)
Vol. 41
Issue 1
Pg. 13-21
(Jan 2003)
ISSN: 1523-6838 [Electronic] United States |
PMID | 12500217
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 2003 by the National Kidney Foundation Inc. |
Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Serum Albumin
- Creatinine
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Topics |
- Adult
- Albuminuria
(blood, etiology)
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Blood Pressure
(drug effects)
- Creatinine
(blood)
- Diabetes Mellitus, Type 2
(blood, drug therapy, pathology, urine)
- Diabetic Nephropathies
(blood, drug therapy, etiology, urine)
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Predictive Value of Tests
- Prospective Studies
- Regression Analysis
- Serum Albumin
(metabolism)
- Smoking
(adverse effects, blood, urine)
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