NEW research found that cardiovascular autonomic neuropathy (CAN) might be a useful marker for long-term complications in patients with Type 2 diabetes (T2D). This retrospective longitudinal study was conducted by Jae Hyeon Kim, Sungkyunkwan University (SKKU), Seoul, South Korea, and colleagues to investigate the association between CAN and incident diabetic kidney disease (DKD).
The study involved 2,033 patients with T2D who did not initially present with renal dysfunction or cardiovascular disease. These conditions were assessed at the start of the study, which involved using cardiovascular autonomic reflex tests to diagnose CAN based on two or more abnormal test results. Additionally, urine albumin-to-creating ratio was taken for detection of albuminuria and the estimated glomerular filtration rate was determined as a measure of kidney function; both values were taken at the start of the study and 3–6 months after.
A DKD diagnosis could be made in the presence of increased albuminuria (urine albumin-to-creating ratio: >30 mg/g at two or more follow-ups), or alternatively if a decline in renal function was detected (estimated glomerular filtration rate: <60 mL/min/1.73 m2 with ≥25% decrease from the start of the study). The researchers found that at an average follow-up of 2.9 years, 290 patients developed DKD, consisting of 79.7% cases of elevated albuminuria, 14.5% decreased kidney function, and 5.8% cases where both were present. Overall, patients who had received a CAN diagnosis were at significantly higher risk of developing DKD.
These findings are particularly relevant as, despite substantial improvements in management of other risk factors such as hypertension in recent years, prevention of DKD remains a challenge in patients with T2D. The authors concluded that the presence of CAN was associated with the development of DKD and, therefore, a CAN diagnosis may be a useful risk indicator for long-term complications in patients with T2D. Most importantly, monitoring of CAN can help to identify patients at high risk for future renal impairment and decrease mortality.