Abstract: PUB074
Progressive Sudomotor Dysfunction in Diabetic Nephropathy: A Cross-Sectional Evaluation Using TM Flow Testing
Session Information
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
- Mandayam, Sreedhar A., The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, United States
- Abbasi, Shehroz, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
Background
Sudomotor dysfunction, reflecting impairment of the autonomic nervous system’s peripheral sympathetic fibers, is an early marker of diabetic neuropathy and is increasingly recognized in patients with CKD. This study aimed to evaluate and compare sudomotor function in patients with type 2 diabetes mellitus and varying degrees of diabetic nephropathy using the TM Flow test, a non-invasive, clinic-based test for autonomic function assessment.
Methods
This cross-sectional study included 63 adults with type 2 diabetes and CKD at a U.S. community clinic. Participants were grouped into Stage 2 (n = 33; eGFR 60–89) and Stage 3 CKD (n = 30; eGFR 30–59). Sudomotor function was assessed using TM Flow, measuring electrochemical skin conductance (ESC) at hands and feet. A composite Sudomotor Function Score (0–4) was calculated, with lower scores indicating greater dysfunction. Statistical analyses were performed using SPSS-25, with normality assessed via Shapiro–Wilk test. Group comparisons used t-tests or Mann–Whitney U tests, with significance set at p < 0.05.
Results
Mean age was 63.1 ± 9.4 years; 55% were male. Sudomotor Function Score was significantly lower in Stage 3 CKD (1.2 ± 0.6) vs. Stage 2 (1.8 ± 0.7; p = 0.011), indicating greater autonomic dysfunction. Foot ESC was lower in Stage 3 (46.3 ± 10.8 μS) vs. Stage 2 (57.1 ± 11.6 μS; p = 0.004), as were hand ESC values (50.6 ± 11.2 μS vs. 59.8 ± 10.5 μS; p = 0.013). More Stage 3 patients (77%) had abnormal/borderline sudomotor dysfunction vs. 45% in Stage 2 (Chi-square = 9.12; p = 0.003). Spearman’s correlation showed an inverse relationship between serum creatinine and Sudomotor Score (ρ = -0.41; p < 0.001), and a positive one with eGFR (ρ = 0.37; p = 0.002). Multivariate regression (adjusting for age, HbA1c, diabetes duration, BMI, and antihypertensive use) confirmed Stage 3 CKD as an independent predictor of lower Sudomotor Score (β = -0.25; 95% CI: -0.42 to -0.07; p = 0.010).
Conclusion
Sudomotor dysfunction is significantly more pronounced in diabetic patients with Stage 3 CKD compared to those with Stage 2 CKD. TM Flow testing provides a sensitive, non-invasive method for detecting early autonomic impairment, with potential utility in risk stratification and early intervention in progressive diabetic kidney disease.