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

Ning Jiang, Feng Huang _ and Xiurong Zhang

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Oncotarget. 2017; 8:93209-93218. https://doi.org/10.18632/oncotarget.21478

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Ning Jiang1, Feng Huang2 and Xiurong Zhang1

1Department of Traditional Chinese Medicine, Maternal and Child Health Care of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health Family Planning Commission of China, Jinan, Shandong Province, China

2Department of Orthopedics, Shandong Provincial Hospital of the Chinese People’s Armed Police Forces, Jinan, Shandong Province, China

Correspondence to:

Feng Huang, email: [email protected]

Keywords: diabetic nephropathy, end stage renal disease, macroalbuminuria, microalbuminuria, cigarette smoking

Received: May 05, 2017     Accepted: September 21, 2017     Published: October 04, 2017


Background: 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.

Materials and Methods: 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.

Results: 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.

Conclusions: 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.

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