Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study

Tahrani, Abd A; Dubb, Kiran; Raymond, Neil T.; Begum, Safia; Sadiqi, Hamed; Piya, Milan K.; Stevens, Martin J.

doi:10.1007/s00125-014-3211-2

Cited by 68 publications

(58 citation statements)

References 44 publications

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“…Animal data support the role of increased sympathetic activity in the pathogenesis of renal disease (30). A recent study of adults with type 2 diabetes found that cardiac autonomic dysfunction was associated with increased albuminuria and lower eGFR at baseline and also predicted subsequent decline in eGFR (31). Clinical studies in adults with type 1 diabetes have been less clear on the role of cardiac autonomic function on renal decline (28,29,32).…”

Section: Discussionmentioning

confidence: 96%

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

et al. 2015

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OBJECTIVEThis study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODSAdolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA 1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTSThe upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA 1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis, upper-tertile ACR was associated with faster heart rate (b = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (b = 29.5, 95% CI 218.2 to 20.8, P = 0.03), independent of age and HbA 1c . CONCLUSIONSAdolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lowerrisk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population.

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Section: Discussionmentioning

confidence: 96%

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

et al. 2015

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“…In addition, among normotensive patients with type 1 diabetes, individuals with CAN had higher nocturnal urinary albumin excretion attributed to an attenuation of nocturnal blood pressure dipping, which is a risk factor for progression of kidney disease (11, 29, 30). In a multiethnic cohort of 204 European and South Asian adults with type 2 diabetes, patients with CAN had lower estimated GFR and higher urinary albumin excretion (5). Similarly, we found negative associations between ACR and cardiac vagal function (E/I, sdNN, HF ratio) in the Pima Indians.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular autonomic neuropathy associates with nephropathy lesions in American Indians with type 2 diabetes

Wheelock¹,

Jaiswal²,

Martin³

et al. 2016

Journal of Diabetes and its Complications

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Aims Cardiovascular autonomic neuropathy (CAN) predicts clinical diabetic nephropathy (DN). We investigated the relationship between DN structural lesions and CAN. Methods Sixty three Pima Indians with type 2 diabetes underwent kidney biopsies following a 6-year clinical trial testing the renoprotective efficacy of losartan vs. placebo. CAN was assessed a median 9.2 years later. CAN variables included expiration/inspiration ratio (E/I), standard deviation of the normal RR interval (sdNN), and low and high frequency signal power and their ratio (LF, HF, LF/HF); lower values reflect more severe neuropathy. Associations of CAN with renal structural variables were assessed by linear regression adjusted for age, sex, diabetes duration, blood pressure, HbA1c, glomerular filtration rate, and treatment assignment during the trial. Results Global glomerular sclerosis was negatively associated with sdNN (partial r = −0.35, p = 0.01) and LF (r = −0.32, p = 0.02); glomerular basement membrane width was negatively associated with all measures of CAN except for LF/HF (r = −0.28 to −0.42, p<0.05); filtration surface density was positively associated with sdNN, LF, and HF (r = 0.31 to 0.38, p<0.05); and cortical interstitial fractional volume was negatively associated with HF (r = −0.27, p = 0.04). Conclusions CAN associates with DN lesions.

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“…QT prolongation may lead to severe ventricular arrhythmias and a 2-fold risk of stroke [5]. There is emerging evidence that CAN is an independent predictor of the development and progression of diabetic nephropathy [6,7].…”

Section: Abbreviationsmentioning

confidence: 99%

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

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et al. 2016

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Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study

Cited by 68 publications

References 44 publications

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

Cardiovascular autonomic neuropathy associates with nephropathy lesions in American Indians with type 2 diabetes

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

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