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Kidney Week

Abstract: PO0975

Cardiovascular Autonomic Dysfunction Is Associated with Decline in Kidney Function in Type 2 Diabetes and Healthy Controls

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Laursen, Jens christian, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Rasmussen, Ida, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Hein Zobel, Emilie, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Hansen, Christian Stevns, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Frimodt-Moller, Marie, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Von Scholten, Bernt Johan, Novo Nordisk AS, Bagsvaerd, Hovedstaden, Denmark
  • Hansen, Tine, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

Cardiovascular autonomic dysfunction is a prevalent and severe complication in type 2 diabetes. We assessed the impact of cardiac autonomic dysfunction on change in kidney function and albuminuria in a cohort of persons with type 2 diabetes and healthy controls.

Methods

In 2013 we recruited 60 persons with type 2 diabetes and 30 controls. Estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (UAER) were measured at baseline and follow up. Cardiovascular reflex tests were performed, and continuous parameters of cardiovascular autonomic function was assessed from heart rate variability in a 5-minute resting ECG.

Results

For the follow up, 32 persons with type 2 diabetes and 21 controls were willing to participate and included in the analyses. Median [IQR] follow-up time was 6.2 [6.0 to 6.3] years. At baseline, mean ± SD age was 60 ± 10 years, median known diabetes duration was 12 [5 to 21] years and mean Hba1c in the type 2 diabetes group was 54 ± 11 mmol/mol. At baseline, mean eGFR was similar between groups (type 2 diabetes: 79 ± 21 ml/min/1.73m2 and controls: 86 ± 12 ml/min/1.73m2 p=0.183) and median UAER was higher (p<0.001) in the type 2 diabetes group (33.5 [6.5 to 107.5] mg/24-h) than controls (5.5 [5.0 to 6.5] mg/24-h).
During follow up, eGFR decreased in both groups (type 2 diabetes: -1.0 (95%CI: -1.4 to -0.5) ml/min/1.73m2/year p<0.001 and controls: -0.7 (95%CI: -1.1 to -0.3) ml/min/1.73m2/year p=0.001) and the change was similar between groups (p=0.179). Albuminuria did not change.
After adjustment for age, sex, smoking, Hba1c, body mass index, heart rate, 24-hour systolic blood pressure, plasma cholesterol, baseline UAER and baseline eGFR, a lower response in heart rate variability during Valsalva (p=0.016) and a lower SDNN (p=0.029) were significantly associated with a steeper yearly decline in eGFR. Cardiovascular autonomic function was not associated with change in albuminuria.

Conclusion

Cardiovascular autonomic dysfunction assessed by heart rate variability was associated with steeper decline in kidney function during 6 years of follow up. Cardiovascular autonomic dysfunction may be a marker of higher risk of decline in eGFR. Whether there is a causal link remains to be established.