Diabetes Care, Vol 16, Issue 5 773-779, Copyright © 1993 by American Diabetes Association

ARTICLES

Autonomic neuropathy predicts deterioration in glomerular filtration rate in patients with IDDM

G Sundkvist and B Lilja
Department of Medicine, University of Lund, Malmo, Sweden.

OBJECTIVE--To evaluate whether autonomic neuropathy predicts deterioration in glomerular filtration rate in IDDM patients. RESEARCH DESIGN AND METHODS--A prospective study in which 35 IDDM patients have been followed for 10-11 yr. Autonomic nerve function tests included heart-rate reactions to deep breathing (expiration-to-inspiration ratio) and to tilt (acceleration and brake indexes). GFR was evaluated by the 51Cr-EDTA plasma clearance method. RESULTS--At entry to the study, no significant differences were noted in age (39 +/- 2 [mean +/- SE] vs. 42 +/- 4 yr), duration of diabetes (20 +/- 3 vs. 23 +/- 4 yr), supine blood pressures (120/79 +/- 3/2 mmHg vs. 121/78 +/- 6/3 mmHg), and GFR (113 +/- 6 vs. 107 +/- 3 ml.min-1.1.73 m-2) between 20 patients with and 15 without autonomic neuropathy (age-corrected criteria). After 10-11 yr, GFR had decreased significantly (22 +/- 4 ml.min-1.1.73 m-2, P < 0.001) in patients with autonomic neuropathy but not (8 +/- 5 ml.min-1.1.73 m-2, NS) in patients without. In keeping with this, GFR decreased more than expected (difference in GFR/expected decrease in GFR) in patients with autonomic neuropathy, compared with those without (4.46 +/- 0.98 vs. 0.48 +/- 0.73, P < 0.005). CONCLUSIONS--Autonomic neuropathy predicts future deterioration in GFR in IDDM patients.
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