What question did this study set out to answer?

To determine whether autonomic neuropathy predicts long-term deterioration in glomerular filtration rate in patients with insulin-dependent diabetes mellitus (IDDM).

May 1, 1993Diabetes Care

Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM

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Why the study?

Does autonomic neuropathy predict deterioration in glomerular filtration rate in patients with IDDM?

Key Points

To determine whether autonomic neuropathy predicts long-term deterioration in glomerular filtration rate in patients with insulin-dependent diabetes mellitus (IDDM).
Prospective cohort follow-up of 35 patients with IDDM over a 10–11-year period.
Autonomic nerve function assessed using heart-rate variation during deep breathing (expiration-to-inspiration ratio) and tilt testing (acceleration and brake indexes).
Glomerular filtration rate (GFR) measured via the 51Cr-EDTA plasma clearance method.
Baseline age (39 ± 2 vs. 42 ± 4 years), diabetes duration (20 ± 3 vs. 23 ± 4 years), blood pressure (120/79 ± 3/2 vs. 121/78 ± 6/3 mmHg), and GFR (113 ± 6 vs. 107 ± 3 ml·min⁻¹·1.73 m⁻²) showed no significant differences between the 20 patients with and 15 without autonomic neuropathy.
After 10–11 years, GFR declined significantly in patients with autonomic neuropathy (22 ± 4 ml·min⁻¹·1.73 m⁻², P < 0.001) but not in those without autonomic neuropathy (8 ± 5 ml·min⁻¹·1.73 m⁻², P = NS).
The ratio of observed to expected GFR decrease was significantly higher in patients with autonomic neuropathy compared to those without (4.46 ± 0.98 vs. 0.48 ± 0.73, P < 0.005).

Structured PICO

Does autonomic neuropathy predict deterioration in glomerular filtration rate in patients with IDDM?

Population

35 patients with Insulin-Dependent Diabetes Mellitus (IDDM), including 20 with and 15 without autonomic neuropathy.

Intervention

Presence of autonomic neuropathy (observational exposure)

Comparator

Absence of autonomic neuropathy

Outcome

Deterioration in glomerular filtration rate (GFR) evaluated by the 51Cr-EDTA plasma clearance method after 10-11 yearssurrogate

Autonomic neuropathy is a significant predictor of future GFR deterioration in patients with insulin-dependent diabetes mellitus over a 10-11 year period.

Discussion

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Implication

May flag IDDM patients at risk for faster GFR decline; leaves open whether screening or interventions alter renal outcomes.

Cite This Study

Sundkvist et al. (1993) studied this question.

synapsesocial.com/papers/6a836aea954bb9d4ab71d6eb https://doi.org/10.2337/diacare.16.5.773

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Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Autonomic Neuropathy Predicts Deterioration in Glomerular Filtration Rate in Patients With IDDM

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider