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J Diabetes Complications. 2016 Jul;30(5):873-9. doi: 10.1016/j.jdiacomp.2016.03.008. Epub 2016 Mar 11.

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

Author information

1
Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ.
2
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
3
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
4
Southwest Kidney Institute, Phoenix, AZ.
5
Department of Neurology, University of Michigan Medical School, Ann Arbor, MI.
6
Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ. Electronic address: rnelson@phx.niddk.nih.gov.

Abstract

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 9.2years later. CAN variables included expiration/inspiration ratio (E/I), standard deviation of the normal R-R 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.

KEYWORDS:

American Indians; Cardiovascular autonomic neuropathy; Diabetic nephropathy; Kidney biopsy; Type 2 diabetes

PMID:
27041674
PMCID:
PMC4912901
DOI:
10.1016/j.jdiacomp.2016.03.008
[Indexed for MEDLINE]
Free PMC Article

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