Diabetologia · 2026
Cardiac autonomic neuropathy predicts renal decline in type 1 diabetes mellitus: a 15 year follow-up study.
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Soe Kywe Kywe, Robinson Emma, Oleolo Misbah, Goonoo Mohummad, Sloan Gordon, Heller Simon, Tesfaye Solomon, Marques Jefferson L B, Sourbron Steven, Selvarajah Dinesh
Аннотация
AIMS/HYPOTHESIS: The aim of this study was to determine whether cardiac autonomic neuropathy (CAN) is an independent risk factor for kidney function decline in type 1 diabetes mellitus over a 15 year follow-up period.
METHODS: Eighty seven participants with type 1 diabetes and eGFR >30 ml/min per 1.73 m2 underwent cardiovascular autonomic reflex testing at baseline. Renal data were retrieved at 4 year intervals over 15 years. Stratification of participants into Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease progression prognostic risk was done by using eGFR and urinary albumin/creatinine ratio (UACR). Longitudinal changes in eGFR and UACR were analysed using linear mixed-effects models with adjustment for potential confounders to determine whether CAN is an independent predictor of eGFR and UACR change over 15 years.
RESULTS: At baseline, higher KDIGO risk category was associated with increased severity of CAN (r=0.38, p<0.001) and increase in UACR (p<0.001) compared with the lower risk group. Participants with established CAN at baseline exhibited greater mean (SD) eGFR decline of 14.8 (21.6) ml/min per 1.73 m2, compared with 3.1 (7.3) and 3.3 (7.4) ml/min per 1.73 m2 in the early stage and those without CAN (p=0.004). Mean (SD) increases in UACR were 0.4 (0.9), 11.3 (30.4) and 4 (8.9) mg/mmol for no CAN, early CAN and established CAN (p=0.03), respectively. After adjusting for potential confounders, baseline CAN was independently associated with both accelerated eGFR decline (p=0.018) and greater increases in UACR (p=0.002) over time.
CONCLUSIONS/INTERPRETATION: 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.
METHODS: Eighty seven participants with type 1 diabetes and eGFR >30 ml/min per 1.73 m2 underwent cardiovascular autonomic reflex testing at baseline. Renal data were retrieved at 4 year intervals over 15 years. Stratification of participants into Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease progression prognostic risk was done by using eGFR and urinary albumin/creatinine ratio (UACR). Longitudinal changes in eGFR and UACR were analysed using linear mixed-effects models with adjustment for potential confounders to determine whether CAN is an independent predictor of eGFR and UACR change over 15 years.
RESULTS: At baseline, higher KDIGO risk category was associated with increased severity of CAN (r=0.38, p<0.001) and increase in UACR (p<0.001) compared with the lower risk group. Participants with established CAN at baseline exhibited greater mean (SD) eGFR decline of 14.8 (21.6) ml/min per 1.73 m2, compared with 3.1 (7.3) and 3.3 (7.4) ml/min per 1.73 m2 in the early stage and those without CAN (p=0.004). Mean (SD) increases in UACR were 0.4 (0.9), 11.3 (30.4) and 4 (8.9) mg/mmol for no CAN, early CAN and established CAN (p=0.03), respectively. After adjusting for potential confounders, baseline CAN was independently associated with both accelerated eGFR decline (p=0.018) and greater increases in UACR (p=0.002) over time.
CONCLUSIONS/INTERPRETATION: 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.