Key result
Vitamin D deficiency is linked to reduced systolic nocturnal dipping in advanced diabetic kidney disease.
Why the study?
Abnormal nocturnal dipping in diabetes mellitus links to adverse outcomes, but its association with vitamin D, cardiovascular autonomic neuropathy, and diabetic kidney disease remains unclear.
Cross-Sectional (n=83)
No
Lower vitamin D levels are independently associated with reduced nocturnal blood pressure dipping and greater severity of cardiovascular autonomic neuropathy in patients with type 2 diabetes and advanced diabetic kidney disease.
Hypothesis-generating for vitamin D links to autonomic neuropathy and dipping in advanced DKD; prospective trials needed before practice change.
Background/Objectives: Abnormal nocturnal dipping (ND) in diabetes mellitus is linked to adverse outcomes. Its association with vitamin D (VD), cardiovascular autonomic neuropathy (CAN), and diabetic kidney disease (DKD) remains unclear. We aim to evaluate the association of VD status with ND loss as well as CAN in type 2 diabetes mellitus (T2DM) across different DKD stages. Methods: 83 T2DM patients were included in this cross-sectional study: 36 with early-stage DKD (urine albumin-to-creatinine ratio [UACR] 30–299 mg/g; Group 1) as well as 47 with advanced-stage DKD (UACR ≥ 300 mg/g; Group 2). Results: Patients with advanced DKD exhibited higher CAN prevalence (72.70% vs. 52.80%; p < 0.05), lower 25(OH)D (26.90 ± 9.90 vs. 29.60 ± 8.00 ng/mL; p = 0.05), and lower systolic ND (0.82 ± 8.40 vs. 4.50 ± 7%; p < 0.05). Among patients with advanced DKD, lower 25(OH)D levels, classified according to the Institute of Medicine (IOM) criteria (normal ≥ 20 ng/mL), were associated with reduced systolic ND (1.90 ± 7.80 vs. −5.60 ± 9.30%; p < 0.05), while the Endocrine Society criteria showed a progressive reduction in systolic ND across VD classification (insufficiency 20–29.9, deficiency <20, and sufficiency ≥30 ng/mL), (−5.60 ± 9.30 vs. −0.20 ± 7.30 vs. 3.30 ± 8%, respectively; p < 0.05). Patients with definite/severe CAN exhibited lower systolic ND (−4.38 ± 7.41 vs. 3.34 ± 8.00%; p < 0.01) than those with absent/early CAN. In addition, lower VD levels were associated with greater CAN severity according to both the Endocrine Society criteria (p < 0.01, r = 0.40), and the IOM criteria (p < 0.05, r = 0.30). In the regression model, VD remained an independent predictor of absence of diastolic ND (Rsqr = 0.393; p < 0.05). Conclusions: These findings suggest a potential link between vitamin D status, autonomic dysfunction, and ND in patients with T2DM and advanced DKD.
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Felício et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus with diabetic kidney disease (n=83). Vitamin D deficiency vs. Normal vitamin D levels was evaluated on Systolic nocturnal dipping (%) in advanced diabetic kidney disease (p=<0.05). In patients with type 2 diabetes and advanced diabetic kidney disease, vitamin D deficiency was significantly associated with reduced systolic nocturnal dipping (-5.60% vs 1.90%) and greater severity of cardiovascular autonomic neuropathy.
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