Cardiac autonomic neuropathy predicts renal decline in type 1 diabetes mellitus: a 15 year follow-up study
Authors' conclusion
CAN is an independent predictor of both accelerated eGFR decline and increased albuminuria in type 1 diabetes. The study also explored the relationship between CAN and KDIGO prognostic risk in diabetic kidney disease, demonstrating that increased severity of CAN is associated with higher KDIGO prognostic risk.
Study context
- Population
- Participants with T1D and eGFR >30 ml/min per 1.73 m² who underwent cardiovascular autonomic reflex testing at baseline
- Participants
- 87 participants
- Exposure
- Established cardiac autonomic neuropathy (CAN) vs early CAN vs no CAN at baseline
- Outcome
- Kidney function decline: change in eGFR and UACR
- Follow-up
- 15 years
Methodological details15 year follow-up, linear mixed-effects models adjusted for potential confounders, Renal data retrieved at 4 year intervals over 15 years
- 15 year follow-up
- Linear mixed-effects models adjusted for potential confounders
- Renal data retrieved at 4 year intervals over 15 years
Main finding
As reported in the abstract
Established CAN
14.8
mean · SD 21.6 · ml/min per 1.73 m²
Early CAN
3.1
mean · SD 7.3 · ml/min per 1.73 m²
No CAN
3.3
mean · SD 7.4 · ml/min per 1.73 m²
Established CAN vs No CAN: P = 0.004 · Established CAN vs No CAN: P = 0.018
Observational data: associations, not effects.
Further findings
Mean, mg/mmol
| Outcome | Established CAN | Early CAN | No CAN | P value |
|---|---|---|---|---|
| UACR increase · 15 yearsAcross no CAN, early CAN and established CAN | 4 (SD 8.9) | 11.3 (SD 30.4) | 0.4 (SD 0.9) | P = 0.03 |
| UACR increase · 15 years | P = 0.002 |
- Urinary albumin/creatinine ratio (UACR) increase: adjusted: baseline CAN independently associated with greater UACR increases
Baseline KDIGO risk category and CAN severity
- Higher KDIGO risk category associated with increased CAN severity (r)
- r=0.38, p<0.001
- Higher KDIGO risk category associated with increase in UACR vs lower risk group
- P < 0.001
Original publication
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