, Volume 57, Issue 6, pp 1249–1256 | Cite as

Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study

  • Abd A. Tahrani
  • Kiran Dubb
  • Neil T. Raymond
  • Safia Begum
  • Quratul A. Altaf
  • Hamed Sadiqi
  • Milan K. Piya
  • Martin J. Stevens



The aim of this work was to assess the impact of cardiac autonomic neuropathy (CAN) on the development and progression of chronic kidney disease (CKD) in patients with type 2 diabetes.


We conducted a cohort study in adults with type 2 diabetes. Patients with end-stage renal disease were excluded. CKD was defined as the presence of albuminuria (albumin/creatinine ratio GFR > 3.4 mg/mmol) or an estimated (eGFR) < 60 ml min−1 1.73 m−2. CKD progression was based on repeated eGFR measurements and/or the development of albuminuria. CAN was assessed using heart rate variability.


Two hundred and four patients were included in the analysis. At baseline, the prevalence of CKD and CAN was 40% and 42%, respectively. Patients with CAN had lower eGFR and higher prevalence of albuminuria and CKD. Spectral analysis variables were independently associated with eGFR, albuminuria and CKD at baseline. After a follow-up of 2.5 years, eGFR declined to a greater extent in patients with CAN than in those without CAN (−9.0 ± 17.8% vs −3.3 ± 10.3%, p = 0.009). After adjustment for baseline eGFR and baseline differences, CAN remained an independent predictor of eGFR decline over the follow-up period (β = −3.5, p = 0.03). Spectral analysis variables were also independent predictors of eGFR decline.


CAN was independently associated with CKD, albuminuria and eGFR in patients with type 2 diabetes. In addition, CAN was an independent predictor of the decline in eGFR over the follow-up period. CAN could be used to identify patients with type 2 diabetes who are at increased risk of rapid decline in eGFR, so that preventative therapies might be intensified.


Albuminuria Autonomic neuropathy Cohort study Diabetic nephropathy Estimated glomerular filtration rate Macroalbuminuria Microalbuminuria Type 2 diabetes 



Albumin/creatinine ratio


Cardiac autonomic neuropathy


Chronic kidney disease


Diabetic nephropathy




End-stage renal disease


Heart rate variability


Low-frequency area


Percentage of adjacent R–R intervals that varied by more than 50  ms


Renin–angiotensin–aldosterone system


Respiratory-frequency area


Square root of the mean squared differences of successive RR intervals


Renal replacement therapy


Standard deviation of normal RR intervals

Supplementary material

125_2014_3211_MOESM1_ESM.pdf (853 kb)
ESM(PDF 853 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Abd A. Tahrani
    • 1
    • 2
  • Kiran Dubb
    • 1
  • Neil T. Raymond
    • 3
  • Safia Begum
    • 2
  • Quratul A. Altaf
    • 2
  • Hamed Sadiqi
    • 2
  • Milan K. Piya
    • 4
    • 5
  • Martin J. Stevens
    • 1
    • 2
  1. 1.Centre of Endocrinology, Diabetes and Metabolism, Institute of Biomedical Research, The Medical SchoolUniversity of BirminghamBirminghamUK
  2. 2.Department of Diabetes and EndocrinologyHeart of England NHS Foundation trustBirminghamUK
  3. 3.Division of Health Sciences, Warwick Medical SchoolUniversity of WarwickCoventryUK
  4. 4.Division of Metabolic and Vascular Health, Warwick Medical SchoolUniversity of WarwickCoventryUK
  5. 5.Warwickshire Institute for the Study of Diabetes, Endocrinology and MetabolismUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK

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