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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1462610
This article is part of the Research Topic Renal Dysfunction in Cardiometabolic Disease: Implications of Inflammation and Oxidative Stress View all articles

Cardiovascular autonomic neuropathy and the risk of diabetic kidney disease

Provisionally accepted
Injeong Cho Injeong Cho 1Seohyun Lim Seohyun Lim 1Minjae Kwon Minjae Kwon 1Seung Min Chung Seung Min Chung 2*Jun Sung Moon Jun Sung Moon 2Ji Sung Yoon Ji Sung Yoon 2Kyu Chang Won Kyu Chang Won 2
  • 1 College of Medicine, Yeungnam University, Gyeongsan, North Gyeongsang, Republic of Korea
  • 2 Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea

The final, formatted version of the article will be published soon.

    Background: Cardiovascular autonomic neuropathy (CAN) is known to affect patients with diabetes mellitus (DM) and cause adverse renal outcomes. We aimed to analyze the association between CAN and diabetic kidney disease (DKD). Method: We enrolled 254 DM patients (mean age, 56.7±15.2 years; male: female ratio, 1.17:1) with 19 (7.5%) type 1 DM patients and 235 (92.5%) type 2 DM patients. All patients had undergone cardiovascular autonomic function tests between January 2019 and December 2021 in a tertiary hospital in Korea. Cardiovascular autonomic neuropathy was categorized as normal, early, or definite after measuring three heart rate variability parameters. Diabetic kidney disease refers to a persistently elevated urinary albumin-creatinine ratio (uACR ≥30 mg/g) or reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2). Logistic and Cox regression analyses were performed. Results: Patients with elevated uACR (n=107) and reduced eGFR (n=32) had a higher rate of definite CAN. After adjusting for covariates, definite CAN was associated with elevated uACR (OR=2.4, 95% CI 1.07-5.36) but not with reduced eGFR (OR=3.43, 95% CI 0.62-18.90). A total of 94 patients repeated uACR measurements within 2 years (mean follow-up, 586.3±116.8 days). Both definite and early CAN were independent risk factors for elevated uACR (HR=8.61 and 8.35, respectively; both p<0.05). In addition, high-density lipoprotein cholesterol, ACE inhibitors/angiotensin receptor blockers and glucagon-like peptide-1 receptor agonists were independent protective factors for elevated uACR (HR=0.96, 0.25, and 0.07, respectively; all p<0.05). Conclusion: Cardiovascular autonomic neuropathy is a potential indicator of DKD. Comprehensive management of DKD in the early stages of CAN may prevent microalbuminuria.

    Keywords: Diabetic Nephropathies, Autonomic Nervous System Diseases, Diabetic Neuropathies, Diabetes Complications, Diabetes Mellitus

    Received: 10 Jul 2024; Accepted: 27 Aug 2024.

    Copyright: © 2024 Cho, Lim, Kwon, Chung, Moon, Yoon and Won. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Seung Min Chung, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea

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