Abstract: FR-PO0346
Assessment of Cardiac Autonomic Dysfunction in Diabetic Nephropathy Using TM Flow: A Cross-Sectional Study
Session Information
- Diabetic Kidney Disease: Progression, Predictive Tools, Therapeutics, and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Amer, Rida, Prolato Clinical Research Center, Houston, Texas, United States
- Sajjad, Ahsan, Ibn Sina Community Clinic, Houston, Texas, United States
- Sajjad, Mobeen, Saad Hospital and Cardiac Care Center, Sialkot, Punjab, Pakistan
- Masood, Attique Ur Rehman, Xenon Health, Jersey City, New Jersey, United States
- Butt, Muhammad Daoud, Universiti Malaya, Federal Territory of Kuala Lumpur, Malaysia
- Abbasi, Shehroz, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
- Mandayam, Sreedhar A., The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, United States
Background
Cardiac Autonomic Neuropathy is a common yet underdiagnosed complication of type 2 diabetes, linked to increased cardiovascular risk. Diabetic nephropathy may accelerate autonomic decline, but its stage-wise progression is not well defined. This cross-sectional study assessed cardiac autonomic dysfunction across CKD stages in diabetic patients using TM Flow, a non-invasive autonomic function tool.
Methods
In this cross-sectional study, 63 adults with type 2 diabetes and CKD were grouped into Stage 2 (n = 33; eGFR 60–89) and Stage 3 (n = 30; eGFR 30–59) per KDIGO guidelines. TM Flow testing evaluated Sympathetic/Vagal Balance, Heart Rate Variability (HRV), Baroreflex Sensitivity (BRS), and Sudomotor Score. Tests were conducted under standardized conditions. Data were analyzed using SPSS-25 with t-tests or Mann–Whitney U tests based on normality. Significance was set at p < 0.05.
Results
The mean age of participants was 63.1 ± 9.4 years, with 55% male. Sympathetic/Vagal Balance Ratio was higher in Stage 3 CKD patients (2.91 ± 1.08) than in Stage 2 (2.13 ± 0.87; p = 0.009), indicating increased sympathetic dominance. Resting HRV was reduced in Stage 3 patients (12.5 ± 4.7 ms) versus Stage 2 (18.3 ± 5.2 ms; p = 0.004), reflecting impaired parasympathetic modulation. Baroreflex Sensitivity (BRS) was also lower in Stage 3 (4.9 ± 1.3 ms/mmHg) compared to Stage 2 (6.7 ± 1.6 ms/mmHg; p = 0.002), suggesting compromised cardiovascular autonomic regulation. Sudomotor Function Score was reduced in Stage 3 patients (1.3 ± 0.6) compared to Stage 2 (2.0 ± 0.7; p = 0.012), indicating greater peripheral autonomic dysfunction. Multivariate regression analysis adjusted for age, HbA1c, diabetes duration, BMI, and antihypertensive use confirmed Stage 3 CKD as an independent predictor of reduced HRV (β = -0.29; p = 0.011) and BRS (β = -0.25; p = 0.015).
Conclusion
Cardiac autonomic function is significantly more impaired in diabetic patients with Stage 3 CKD compared to those with Stage 2, as evidenced by elevated sympathetic tone, reduced HRV, and blunted baroreflex activity. These findings underscore the progressive nature of autonomic dysregulation with worsening kidney function and support the role of TM Flow testing in early CAN screening and risk stratification in diabetic CKD populations.