Cardiovascular autonomic neuropathy and incident diabetic kidney disease in patients with type 2 diabetes

Aims: We investigated the association between cardiovascular autonomic neuropathy (CAN) and incident diabetic kidney disease (DKD). Methods: This retrospective longitudinal study included 2,033 patients with type 2 diabetes (mean age 57.2 years, 57.4% male, and median diabetes duration 8.0 years), free of renal dysfunction or cardiovascular disease at initiation. Cardiovascular autonomic reflex tests were performed once at baseline, and CAN was defined as >= 2 abnormal parasympathetic test results. Urine ACR and eGFR were concurrently measured at baseline and every 36 months thereafter. Incident DKD was defined as the development of ACR >= 30 mg/g at two or more follow-up examinations or eGFR < 60 ml/min/1.73 m(2) with >= 25% decrease from baseline. Results: During a median follow-up of 2.9 years (1.1 - 4.8), 290 (14.3%) patients developed DKD, comprising 79.7% (N = 231) cases of new-onset albuminuria alone, 14.5% (N = 42) cases of eGFR decline alone, and 5.8% (N = 17) cases of both. Compared to those without CAN, patients with CAN had a significantly higher risk of incident DKD in a multivariable Cox regression model (HR 1.56, 95% CI 1.15 - 2.12; P = 0.005). Conclusion: CAN is may be a useful marker for long-term complications including DKD in patients with type 2 diabetes. Monitoring of CAN helps to identify high risk patients of future renal impairment. (C) 2021 Elsevier B.V. All rights reserved.

Automated summary

This study investigated the association between cardiovascular autonomic neuropathy (CAN) and incident diabetic kidney disease (DKD). The results showed that patients with CAN had a significantly higher risk of developing DKD compared to those without CAN.