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Diabetes Care 30:e3 2007
DOI: 10.2337/dc06-2420
© 2007 by the American Diabetes Association
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Letters: Comments and Responses

Cigarette Smoking Is Associated With Low Glomerular Filtration Rate in Male Patients With Type 2 Diabetes

Response to Saito et al.

Salvatore De Cosmo, MD1, Olga Lamacchia, MD2, Loreto Gesualdo, MD3, Vincenzo Trischitta, MD1,4 and Mauro Cignarelli, MD2

1 Unit of Endocrinology, the Scientific Institute Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
2 Unit of Endocrinology and Metabolic Diseases, Department of Medical Sciences, University of Foggia, Foggia, Italy
3 Unit of Nephrology, Department of Molecular Medicine, University of Foggia, Foggia, Italy
4 Department of Clinical Sciences, University of Rome La Sapienza, Rome, Italy

Address correspondence to Mauro Cignarelli, MD, Unit of Endocrinology and Metabolic Diseases, Department of Medical Sciences, University of Foggia, via Luigi Pinto, 71100 Foggia, Italy. E-mail: m.cignarelli{at}unifg.it

We thank Saito et al. (1) for their interest and comments regarding our recent article (2). They suggest that the absence of positive correlation between the number of cigarettes smoked per day and severity of nephropathy, as expressed by low glomular filtration rate, might be due to the exclusion of ex-smokers in the analysis. This is possible, given the fact that some studies (3,4) (though not all [5]) including ex-smokers have found the above-mentioned correlation. In fact, both options (i.e., ex-smokers being either included or excluded) have their own rationale (3–6). In our specific context, we decided to design a study aimed at investigating the role of current smoking in modulating the risk of having low glomular filtration rate. Including ex-smokers could weaken the result obtained and conceal the role played by exposure to tobacco smoke on oxidative stress, as we have shown. However, we do acknowledge that the alternative approach, including ex-smokers, would have been equally appropriate if aimed at also determining the effect of previous smoking habit.

References

  1. Saito K, Yamada N, Sone H: Cigarette smoking is associated with low glomerular filtration rate in male patients with type 2 diabetes (Letter). Diabetes Care 30:e2, 2007. DOI: http://dx.doi.org/10.2337/dc06-2295[Free Full Text]
  2. De Cosmo S, Lamacchia O, Rauseo A, Viti R, Gesualdo L, Pilotti A, Trischitta V, Cignarelli M: Cigarette smoking is associated with low glomerular filtration rate in male patients with type 2 diabetes. Diabetes Care 29:2467–2470, 2006[Abstract/Free Full Text]
  3. Sawicki PT, Didjurgeit U, Muhlhauser I, Bender R, Heinemann L, Berger M: Smoking is associated with progression of diabetic nephropathy. Diabetes Care 17:126–131, 1994[Abstract]
  4. Ikeda Y, Suehiro T, Takamatsu K, Yamashita H, Tamura T, Hashimoto K: Effect of smoking on the prevalence of albuminuria in Japanese men with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 36:57–61, 1997[Medline]
  5. Scott LJ, Warram JH, Hanna LS, Laffel LMB, Ryan L, Krolewski AS: A nonlinear effect of hyperglycemia and current cigarette smoking are major determinants of the onset of microalbuminuria in type 1 diabetes. Diabetes 50:2842–2849, 2001[Abstract/Free Full Text]
  6. Chuahirun T, Wesson DE: Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition. Am J Kidney Dis 39:376–382, 2002[Medline]

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This Article
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