J Korean Med Sci.  2009 Jan;24(Suppl 1):S69-S74. 10.3346/jkms.2009.24.S1.S69.

Cardiac Autonomic Neuropathy as a Predictor of Deterioration of the Renal Function in Normoalbuminuric, Normotensive Patients with Type 2 Diabetes Mellitus

  • 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wooseong.huh@samsung.com


Our study was performed to determine whether cardiac autonomic neuropathy can predict deterioration of the renal function in normoalbuminuric, normotensive people with type 2 diabetes mellitus (DM). One hundred and fifty-six normoalbuminuric, normotensive people with type 2 DM were included in our retrospective longitudinal study. We categorized normal patterns, early patterns, and definite or severe patterns according to the results of the cardiac autonomic function test. Of 156 patients included, 54 had normal patterns, 75 had early patterns, 25 had definite or severe patterns, and 2 had atypical patterns. During a median follow-up of nine years, glomerular filtration rates (GFR) remained stable in the normal and early pattern groups (mean changes, 4.50% and 0.77%, respectively) but declined in those with definite or severe patterns (mean change, -10.28%; p=0.047). An abnormal heart response to the deep breathing test of the cardiac autonomic function tests was an independent predictor of GFR decline. Our data suggest that cardiac autonomic neuropathy, especially with a definite or severe pattern, might be associated with a subsequent deterioration in renal function in normoalbuminuric, normotensive people with type 2 DM.


Autonomic Neuropathy; Glomerular Filtration Rate; Diabetes Mellitus, Type 2

MeSH Terms

Blood Pressure
Diabetes Complications
Diabetes Mellitus, Type 2/*diagnosis/*pathology
Follow-Up Studies
Glomerular Filtration Rate
Heart Diseases/*complications
Heart Rate
Kidney Diseases/*therapy
Middle Aged
Neurodegenerative Diseases/*complications


  • Fig. 1 Cumulative incidence of the development of hypertension in 154 initially normoalbuminuric, normotensive people with type 2 diabetes over a nine-year follow-up.

Cited by  1 articles

Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet
Vincenza Spallone
Diabetes Metab J. 2019;43(1):3-30.    doi: 10.4093/dmj.2018.0259.


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