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A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy.

Forsén, A; Kangro, M; Sterner, Gunnar LU ; Norrgren, Kristina LU ; Thorsson, Ola LU ; Wollmer, Per LU and Sundkvist, Göran LU (2004) In Diabetic Medicine 21(8). p.852-858
Abstract
Aims Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.



Methods Autonomic nerve function was assessed by heart-rate responses to deep breathing (E/I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria > 20 µg/min or > 0.03 g/24 h) and glomerular filtration rate (51Cr-EDTA plasma clearance). The acceleration index had deteriorated after 7 years (P = 0.0155), whereas the E/I ratio (P = 0.0070) and the diastolic... (More)
Aims Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.



Methods Autonomic nerve function was assessed by heart-rate responses to deep breathing (E/I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria > 20 µg/min or > 0.03 g/24 h) and glomerular filtration rate (51Cr-EDTA plasma clearance). The acceleration index had deteriorated after 7 years (P = 0.0155), whereas the E/I ratio (P = 0.0070) and the diastolic postural blood pressure reaction (P = 0.0054) had deteriorated 14 years after the baseline examination (age-corrected values). All those with albuminuria at the third examination showed signs of autonomic neuropathy at baseline (10 of 10) compared with only nine of 22 without (P = 0.0016). Multiple regression analysis showed that the association between autonomic dysfunction and future albuminuria was due to the E/I ratio. In addition, individuals with an abnormal postural diastolic blood pressure fall (n = 7) at baseline showed a greater fall in glomerular filtration rate more than others 7-14 years later [29 (16.5) ml/min/1.72 m2 vs. 11 (9) ml/min/1.72 m2; P = 0.0074].



Conclusion Autonomic nerve function had deteriorated after 14 years. Autonomic neuropathy and abnormal postural diastolic blood pressure falls at baseline were associated with future renal complications. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetic Medicine
volume
21
issue
8
pages
852 - 858
publisher
Wiley-Blackwell
external identifiers
  • wos:000222821700008
  • pmid:15270788
  • scopus:3843128721
ISSN
1464-5491
DOI
10.1111/j.1464-5491.2004.01255.x
language
English
LU publication?
yes
id
4ef772b4-dae8-47d8-ace5-d36b652f10a6 (old id 125691)
date added to LUP
2007-07-19 11:19:57
date last changed
2017-11-19 04:06:20
@article{4ef772b4-dae8-47d8-ace5-d36b652f10a6,
  abstract     = {Aims Prospective studies of autonomic nerve function are rare. We have followed the progression of autonomic dysfunction in relation to nephropathy over 14 years in Type 1 diabetic patients.<br/><br>
<br/><br>
Methods Autonomic nerve function was assessed by heart-rate responses to deep breathing (E/I ratio) and tilting (acceleration and brake indices) and by the postural blood pressure reaction in 58 patients, 43 of whom were reassessed after 14 years. Nephropathy was evaluated by the degree of albuminuria (albuminuria &gt; 20 µg/min or &gt; 0.03 g/24 h) and glomerular filtration rate (51Cr-EDTA plasma clearance). The acceleration index had deteriorated after 7 years (P = 0.0155), whereas the E/I ratio (P = 0.0070) and the diastolic postural blood pressure reaction (P = 0.0054) had deteriorated 14 years after the baseline examination (age-corrected values). All those with albuminuria at the third examination showed signs of autonomic neuropathy at baseline (10 of 10) compared with only nine of 22 without (P = 0.0016). Multiple regression analysis showed that the association between autonomic dysfunction and future albuminuria was due to the E/I ratio. In addition, individuals with an abnormal postural diastolic blood pressure fall (n = 7) at baseline showed a greater fall in glomerular filtration rate more than others 7-14 years later [29 (16.5) ml/min/1.72 m2 vs. 11 (9) ml/min/1.72 m2; P = 0.0074].<br/><br>
<br/><br>
Conclusion Autonomic nerve function had deteriorated after 14 years. Autonomic neuropathy and abnormal postural diastolic blood pressure falls at baseline were associated with future renal complications.},
  author       = {Forsén, A and Kangro, M and Sterner, Gunnar and Norrgren, Kristina and Thorsson, Ola and Wollmer, Per and Sundkvist, Göran},
  issn         = {1464-5491},
  language     = {eng},
  number       = {8},
  pages        = {852--858},
  publisher    = {Wiley-Blackwell},
  series       = {Diabetic Medicine},
  title        = {A 14-year prospective study of autonomic nerve function in Type 1 diabetic patients: association with nephropathy.},
  url          = {http://dx.doi.org/10.1111/j.1464-5491.2004.01255.x},
  volume       = {21},
  year         = {2004},
}