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Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies.

ABSTRACT: Conflicting evidence exists for observational studies on whether tobacco smoking is a risk factor for diabetic nephropathy (DN) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In this meta-analysis, we aimed to assess the effects of tobacco smoking on the development of DN.We searched MEDLINE and EMBASE databases from their inception to March 31st, 2017 for cross-sectional, case-control, and prospective cohort studies. We screened reference lists of retrieved articles. Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.A total of nineteen observational studies (1 case-control, 8 cross-sectional and 10 prospective cohort studies) were identified, involving more than 78,000 participants and a total of 17,832 DN cases. Compared with never-smokers, there was an augmented SRR (95% CI) of DN in ever-smokers in patients with T1DM (1.31 [1.06-1.62]; P = 0.006) and T2DM (1.44 [1.24-1.67]; P < 0.001), respectively. In patients with T1DM, the SRR (95% CI) was 1.25 (0.86-1.83) for microalbuminuria only, 1.27 (1.10-1.48) for macroalbuminuria only, and 1.06 (0.97-1.15) for end-stage renal disease (ESRD). In patients with T2DM, the SRR (95% CI) associated with ever smoking was 1.46 (0.94-2.26) for microalbuminuria only, 1.72 (1.04-2.84) for macroalbuminuria only, and 1.10 (0.36-3.33) for ESRD.Our meta-analysis suggests evidence for cigarette smoking as an independent risk factor for the development of DN in patients with both T1DM and T2DM.

SUBMITTER: Jiang N

PROVIDER: S-EPMC5696256 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies.

Jiang Ning N Huang Feng F Zhang Xiurong X

Oncotarget 20171004 54

<h4>Background</h4>Conflicting evidence exists for observational studies on whether tobacco smoking is a risk factor for diabetic nephropathy (DN) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). In this meta-analysis, we aimed to assess the effects of tobacco smoking on the development of DN.<h4>Materials and methods</h4>We searched MEDLINE and EMBASE databases from their inception to March 31<sup>st</sup>, 2017 for cross-sectional, case-control, and prospective cohort studie ...[more]

PMID: 29190990

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Project description:Background:Diabetic nephropathy (DN) is an important cause of end-stage renal disease and is recognized as a public health problem worldwide. However, there have been no nationwide surveys of DN prevalence in China. This study is aimed at estimating the pooled prevalence of DN among patients with type 2 diabetes in China. Methods:Published studies on the prevalence of DN among patients with type 2 diabetes published from January 1980 to October 2019 were systematically reviewed using PubMed, Embase, Google Scholar, Chinese Wanfang databases, and Chinese National Knowledge Infrastructure. The pooled prevalence of DN was estimated with the random effects model using R software. Prevalence estimates were also stratified by study design, methodological approach, and study population characteristics. Results:Thirty studies with a total of 79,364 participants were included in our study. The overall pooled prevalence of DN was 21.8% [95% confidence interval (CI): 18.5-25.4%]. Subgroup analysis found that the prevalence of DN varied significantly according to different DM and DN diagnostic criteria (P < 0.05); the pooling estimate was the highest in the west region of 41.3%, followed by that in the east region of China with 22.3%, northeast region with 20.7%, and central region with 15.6% (P < 0.05); the pooling estimate was the highest in the west region of 41.3%, followed by that in the east region of China with 22.3%, northeast region with 20.7%, and central region with 15.6% (P < 0.05); the pooling estimate was the highest in the west region of 41.3%, followed by that in the east region of China with 22.3%, northeast region with 20.7%, and central region with 15.6% (. Conclusions:The prevalence of DN is high in Chinese patients with type 2 diabetes and shows geographic and gender variation. These data indicate that national strategies aimed at primary and secondary prevention of DN and screening programs for DN are urgently needed to reduce the risk and burden of DN in China.

Project description:BACKGROUND:Observational studies suggested that tobacco smoking was associated with diabetic nephropathy (DN). However, the results were conflicting and inconsistent. In the study, we performed a meta-analysis to assess the relationship between tobacco smoking and the development of DN. MATERIALS AND METHODS:We searched in PubMed, Embase, Web of Science and the Cochrane Library (CENTRAL) from database inception until Mar 8, 2018, and updated our search on May 1, 2018. We screened the reference lists of the retrieved articles. Only original prospective cohort studies which have investigated the association between smoking and DN incidence or its progression were included. Pooled HRs and 95% confidence intervals (CIs) were calculated using a random effects model. RESULTS:A total of 9 prospective cohort studies were identified, including more than 203337 participants. Compared with those of no smoking, smoking participants increased the risk of developing DN (HR = 1.07, 95% CI: 1.01-1.13, P = 0.01). The subgroup analysis showed that the current and total smoking may increase the risk of DN, but these results did not reach statistical significance (current: HR = 1.69, 95% CI = 0.79-3.64, p = 0.17; total: HR = 1.17, 95% CI = 0.97-1.41, p = 0.10), whereas former smoking significantly increased the risk of DN (HR = 1.04, 95% CI = 1.03-1.05, p<0.001). Compared with no-smokers, smokers showed an elevated risk of developing DN (HR = 1.05; 95% CI, 1.00-1.11, P = 0.05). In patients with T2DM, those who smoked were at an increased risk of developing DN, as compared to those who had never smoked (HR = 1.05; 95% CI, 1.00-1.11, P = 0.05). However, compared to no smoking, smoking did not increase the risk of DN development in patients with T2DM (HR = 1.15; 95% CI, 0.9-1.47, P = 0.25). Univariate and multivariate meta-regression did not find any confounding factors. No publication bias was found in the meta-analysis. CONCLUSIONS:The present study highlighted that smoking was an independent risk factor for DN, especially in patients with T1DM. This is the first meta-analysis of prospective cohort studies to discuss the relationship between smoking and DN.

Dataset Information

Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies.

Publications

Smoking and the risk of diabetic nephropathy in patients with type 1 and type 2 diabetes: a meta-analysis of observational studies.

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