NEW YORK (Reuters Health) - Diabetic kidney disease may worsen quickly despite therapy if patients continue to smoke, new research shows.

The study of 33 type 2 diabetics with kidney disease showed that smokers' kidney function declined more rapidly than nonsmokers', despite drug treatment with ACE inhibitors. These drugs, which lower blood pressure, have been shown to slow the progression of diabetic kidney disease, or nephropathy.

But in this study, doctors at Texas Tech University Health Sciences Center in Lubbock found that even though ACE inhibitors lowered smokers' blood pressure, these patients still saw their kidney function go downhill. Nonsmokers' kidney health also declined, but to a lesser degree, according to findings published in the February issue of the American Journal of Kidney Diseases.

"Treating diabetic nephropathy with improved blood pressure control and ACE inhibitor therapy fails to eradicate the untoward effects of cigarette smoking," conclude Drs. Temduang Chuahirun and Donald E. Wesson.

And although this study doesn't prove it, they add, smoking cessation might slow the progression of kidney disease toward total kidney failure in diabetics on ACE inhibitors.

Diabetes is a leading cause of kidney failure. Exactly why smoking might speed the decline in kidney function is not fully clear, according to the Texas researchers. But, among other things, cigarette smoking is known to increase resistance in the kidney's blood vessels and to increase blood levels of certain compounds that cause blood vessels to constrict.

Whatever the mechanism, Chuahirun and Wesson note, it seems "prudent" to get patients to quit smoking as one way to prevent total kidney failure.

SOURCE: American Journal of Kidney Diseases 2002;39:376-382.

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