***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : We describe baseline renal function and albumin excretion rate in patients enrolled in Bypass Angioplasty Revascularization Investigation 2 Diabetes , a r and omized clinical trial comparing the impact of revascularization and medical therapy with medical therapy alone and deferred or no revascularization and the impact of glycemic control with either insulin-providing or insulin-sensitizing drugs , on 5-year mortality . Methods : Study participants had type 2 diabetes mellitus , documented coronary artery disease , and creatinine < 2 mg/dL. Albuminuria status ( albumin/creatinine ratio [ ACR ] ) and estimated glomerular filtration rate ( eGFR ) , using the abbreviated Modified Diet in Renal Disease equation , were determined at baseline . Univariate and multivariate relationships between baseline clinical characteristics and the presence of albuminuria and reduced eGFR rate were estimated . Results : Two thous and one hundred forty-six subjects were included in the analysis . Forty-three percent of the cohort had evidence of kidney dysfunction at baseline : 23 % had an eGFR ≥60 mL/min/1.73 m2 with either microalbuminuria ( > 30 ACR ; 17 % ) or macroalbuminuria ( > 300 ACR ; 6 % ) . Twenty-one percent had a reduced eGFR < 60 mL/min/1.73 m2 ; 52 % with reduced eGFR had no albuminuria ; 28 % had microalbuminuria , and 20 % had macroalbuminuria . Race , smoking status , duration of diabetes , hypertension , hemoglobin A1c , triglycerides , vascular disease , abnormal ejection fraction , and reduced eGFR were associated with greater albuminuria . Age , sex , duration of diabetes , ACR , hemoglobin A1c , high density lipoprotein , and number of hypertensive medications were associated with reduced eGFR . Conclusion : Kidney dysfunction is common in older patients with type 2 diabetes mellitus and coronary artery disease ; Albuminuria was present in 33 % . Reduced eGFR was present in 21 % , and half the patients with reduced eGFR had no evidence of albuminuria OBJECTIVE The first sign of diabetic nephropathy is microalbuminuria , but its predictive role of progression to overt nephropathy in type 2 diabetes has not yet been clarified . The aims of this study were to assess during 7 years of follow-up the incidence rate of overt nephropathy and the predictive role of microalbuminuria and other baseline variables ( blood pressure , lipids , fibrinogen , uric acid , smoking , and HbA(1c ) cumulative average during follow-up ) . RESEARCH DESIGN AND METHODS A prospect i ve population -based study was performed in Casale Monferrato , Italy , including 1,253 type 2 diabetic patients recruited at baseline ( 1991 - 1992 ) , 765 with normoalbuminuria ( albumin excretion rate [ AER ] < 20 microg/min ) and 488 with microalbuminuria ( AER 20 - 200 microg/min ) . All measurements were central ized . A nested case-control study within the cohort was performed , selecting four control subjects , frequency matched for age and attained individual time of follow-up with each case . Conditional regression analysis was performed to assess variables independently associated with risk of progression to overt nephropathy . RESULTS Of 1,253 total patients , 1,103 ( 88.0 % ) were included in the follow-up examination ( median 5.33 years ) ; their age and duration of disease at baseline were 68.4 + /- 10.5 years and 10.4 + /- 6.6 years , respectively . Cases of overt nephropathy were 202 , giving an incidence rate of 37.0/1,000 person-years ( 95 % CI 32.3 - 42.6 ) . In conditional logistic regression analyses , microalbuminuria provided a 42 % increased risk with respect to normoalbuminuria ( 95 % CI 0.98 - 2.06 ) , independently of duration of diabetes , hypertension , and systolic blood pressure . Other variables independently associated with progression to overt nephropathy were HbA(1c ) cumulative average ( P = 0.002 ) , apolipoprotein B ( P = 0.013 ) , fibrinogen ( P = 0.02 ) , and HDL cholesterol ( P = 0.03 ) . CONCLUSIONS Of type 2 diabetic patients , 3.7 % progress every year to overt nephropathy . Microalbuminuria is associated with a 42 % increased risk of progression to overt nephropathy . Other independent predictors are HbA(1c ) , HDL cholesterol , apolipoprotein B , and fibrinogen IMPORTANCE Smoking cessation reduces the risks of cardiovascular disease ( CVD ) , but weight gain that follows quitting smoking may weaken the CVD benefit of quitting . OBJECTIVE To test the hypothesis that weight gain following smoking cessation does not attenuate the benefits of smoking cessation among adults with and without diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve community-based cohort study using data from the Framingham Offspring Study collected from 1984 through 2011 . At each 4-year examination , self-reported smoking status was assessed and categorized as smoker , recent quitter ( ≤ 4 years ) , long-term quitter ( > 4 years ) , and nonsmoker . Pooled Cox proportional hazards models were used to estimate the association between quitting smoking and 6-year CVD events and to test whether 4-year change in weight following smoking cessation modified the association between smoking cessation and CVD events . MAIN OUTCOME MEASURE Incidence over 6 years of total CVD events , comprising coronary heart disease , cerebrovascular events , peripheral artery disease , and congestive heart failure . RESULTS After a mean follow-up of 25 ( SD , 9.6 ) years , 631 CVD events occurred among 3251 participants . Median 4-year weight gain was greater for recent quitters without diabetes ( 2.7 kg [ interquartile range { IQR } , -0.5 to 6.4 ] ) and with diabetes ( 3.6 kg [ IQR , -1.4 to 8.2 ] ) than for long-term quitters ( 0.9 kg [ IQR , -1.4 to 3.2 ] and 0.0 kg [ IQR , -3.2 to 3.2 ] , respectively , P < .001 ) . Among participants without diabetes , age- and sex-adjusted incidence rate of CVD was 5.9 per 100 person-examinations ( 95 % CI , 4.9 - 7.1 ) in smokers , 3.2 per 100 person-examinations ( 95 % CI , 2.1 - 4.5 ) in recent quitters , 3.1 per 100 person-examinations ( 95 % CI , 2.6 - 3.7 ) in long-term quitters , and 2.4 per 100 person-examinations ( 95 % CI , 2.0 - 3.0 ) in nonsmokers . After adjustment for CVD risk factors , compared with smokers , recent quitters had a hazard ratio ( HR ) for CVD of 0.47 ( 95 % CI , 0.23 - 0.94 ) and long-term quitters had an HR of 0.46 ( 95 % CI , 0.34 - 0.63 ) ; these associations had only a minimal change after further adjustment for weight change . Among participants with diabetes , there were similar point estimates that did not reach statistical significance . CONCLUSIONS AND RELEVANCE In this community-based cohort , smoking cessation was associated with a lower risk of CVD events among participants without diabetes , and weight gain that occurred following smoking cessation did not modify this association . This supports a net cardiovascular benefit of smoking cessation , despite subsequent weight gain Blood pressure reduction and angiotensin-converting enzyme ( ACE ) inhibitors slow but do not stop progressive decline of renal function in established diabetic nephropathy ( DN ) , but predictors of this decline in patients undergoing these interventions are unknown . We prospect ively examined patients to determine whether age , sex , ethnicity , mean blood pressure , plasma creatinine , urine protein excretion , and cigarette smoking predict renal function decline in type 2 DN treated toward the recommended mean blood pressure goal of 92 mm Hg ( about 125/75 mm Hg ) with antihypertensives including ACE inhibitors .  Thirty-three DN patients with initial plasma creatinine less than 1.4 mg/dL were followed 64.0 + /- 1.1 months . After correcting for differences in follow-up time , demographic variables , and other relevant variables , plasma creatinine increased , indicating renal function decline despite mean blood pressure reduction to 92 + /- 1 mm Hg and administration of ACE inhibitors . Regression analysis showed that smoking was the only examined parameter that significantly predicted renal function decline . Smokers ( n = 13 ) and nonsmokers ( n = 20 ) had similar follow-up ( 61.4 + /- 2.1 months versus 65.7 + /- 1.1 months ) , mean blood pressure ( 91 + /- 1 mm Hg versus 92 + /- 1 mm Hg ) , and initial plasma creatinine ( 1.05 + /- 0.08 mg/dL versus 1.08 + /- 0.03 mg/dL ) . Nevertheless , follow-up plasma creatinine was higher in smokers than nonsmokers ( 1.78 + /- 0.20 mg/dL versus 1.32 + /- 0.04 mg/dL ) . The data show that renal function declines faster in smokers than nonsmokers with type 2 DN undergoing treatment to improve blood pressure including ACE inhibitors . Cigarette smoking remains a risk factor for renal function decline in type 2 DN despite currently recommended therapy Objectives To describe independent predictors for the development of microalbuminuria and progression to macroalbuminuria in those with childhood onset type 1 diabetes . Design Prospect i ve observational study with follow-up for 9.8 ( SD 3.8 ) years . Setting Oxford regional prospect i ve study . Participants 527 participants with a diagnosis of type 1 diabetes at mean age 8.8 ( SD 4.0 ) years . Main outcome measures  Annual measurement of glycated haemoglobin ( HbA1c ) and assessment of urinary albumin : creatinine ratio . Results Cumulative prevalence of microalbuminuria was 25.7 % ( 95 % confidence interval 21.3 % to 30.1 % ) after 10 years of diabetes and 50.7 % ( 40.5 % to 60.9 % ) after 19 years of diabetes and 5182 patient years of follow-up . The only modifiable adjusted predictor for microalbuminuria was high HbA1c concentrations ( hazard ratio per 1 % rise in HbA1c 1.39 , 1.27 to 1.52 ) . Blood pressure and history of smoking were not predictors . Microalbuminuria was persistent in 48 % of patients . Cumulative prevalence of progression from microalbuminuria to macroalbuminuria was 13.9 % ( 12.9 % to 14.9 % ) ; progression occurred at a mean age of 18.5 ( 5.8 ) years . Although the sample size was small , modifiable predictors of macroalbuminuria were higher HbA1c levels and both persistent and intermittent microalbuminuria ( hazard ratios 1.42 ( 1.22 to 1.78 ) , 27.72 ( 7.99 to 96.12 ) , and 8.76 ( 2.44 to 31.44 ) , respectively ) . Conclusion In childhood onset type 1 diabetes , the only modifiable predictors were poor glycaemic control for the development of microalbuminuria and poor control and microalbuminuria ( both persistent and intermittent ) for progression to macroalbuminuria . Risk for macroalbuminuria is similar to that observed in cohorts with adult onset disease but as it occurs in young adult life early intervention in normotensive adolescents might be needed to improve prognosis INTRODUCTION There is an established role of clinical risk factors such as arterial hypertension and smoking in causing cardiovascular morbidity and diabetic nephropathy ( DNP ) . Genetic factors increase the risk for DNP . To examine the genetic risk , we initiated a case-control study with predefined follow-up examinations . We describe the study design and baseline characteristics under special consideration of comedication , and give preliminary results of the 4-year follow-up . METHODS We enrolled all 477 patients with DNP receiving maintenance hemodialysis in 30 centers in Southern Germany between August 1999 and January 2000 . As controls , we enrolled all 482 diabetes mellitus type 2 patients without urinary microalbuminuria in two examinations on consecutive days and without other signs of renal disease in a large diabetes clinic from September 2000 to September 2001 . Follow-up examinations are 
    Output:
    
When the smoking status was adjusted in a mixed effect meta-regression model , the duration of diabetes was the only statistically significant factor that influenced the prevalence of albuminuria .
Conclusions Continuing to smoke and the duration of diabetes are two strong predictors of albuminuria in smokers with T2DM .