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

• Published in: Journal of diabetes and its complications 2016-07, Vol.30 (5), p.873-879
• Main Authors: Wheelock, Kevin M, Jaiswal, Mamta, Martin, Catherine L, Fufaa, Gudeta D, Weil, E. Jennifer, Lemley, Kevin V, Yee, Berne, Feldman, Eva, Brosius, Frank C, Knowler, William C, Nelson, Robert G, Pop-Busui, Rodica
• Format: Article
• Language: English
• Subjects: Adult; American Indians; Arizona; Autonomic Nervous System - physiopathology; Autonomic Nervous System Diseases - complications; Autonomic Nervous System Diseases - ethnology; Autonomic Nervous System Diseases - physiopathology; Biopsy; Blood pressure; Cardiovascular autonomic neuropathy; Cardiovascular Diseases - complications; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - physiopathology; Cardiovascular System - innervation; Cardiovascular System - physiopathology; Clinical trials; Cohort Studies; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - ethnology; Diabetic Angiopathies - ethnology; Diabetic Angiopathies - physiopathology; Diabetic Cardiomyopathies - ethnology; Diabetic Cardiomyopathies - physiopathology; Diabetic Nephropathies - ethnology; Diabetic Nephropathies - pathology; Diabetic Nephropathies - physiopathology; Diabetic nephropathy; Diabetic Neuropathies - ethnology; Diabetic Neuropathies - physiopathology; Endocrinology & Metabolism; Endothelium; Female; Heart rate; Humans; Indians, North American; Kidney - innervation; Kidney - pathology; Kidney - physiopathology; Kidney biopsy; Kidney diseases; Longitudinal Studies; Male; Middle Aged; Mortality; Renal Insufficiency - complications; Renal Insufficiency - ethnology; Renal Insufficiency - pathology; Renal Insufficiency - physiopathology; Sclerosis; Severity of Illness Index; Standard deviation; Type 2 diabetes
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2016.03.008

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 9.2 years 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.