title: Cardiovascular autonomic neuropathy associates with nephropathy lesions in American Indians with type 2 diabetes.
abstract: Cardiovascular autonomic neuropathy (CAN) predicts clinical diabetic nephropathy (DN). We investigated the relationship between DN structural lesions and CAN.
  
  
  
  Sixty three Pima Indians with type 2 diabetes underwent kidney biopsies following a 6-year clinical trial testing the renoprotective efficacy of losartan vs. placebo. CAN was assessed a median 9.2years later. CAN variables included expiration/inspiration ratio (E/I), standard deviation of the normal R-R interval (sdNN), and low and high frequency signal power and their ratio (LF, HF, LF/HF); lower values reflect more severe neuropathy. Associations of CAN with renal structural variables were assessed by linear regression adjusted for age, sex, diabetes duration, blood pressure, HbA1c, glomerular filtration rate, and treatment assignment during the trial.
  
  
  
  Global glomerular sclerosis was negatively associated with sdNN (partial r=-0.35, p=0.01) and LF (r=-0.32, p=0.02); glomerular basement membrane width was negatively associated with all measures of CAN except for LF/HF (r=-0.28 to -0.42, p<0.05); filtration surface density was positively associated with sdNN, LF, and HF (r=0.31 to 0.38, p<0.05); and cortical interstitial fractional volume was negatively associated with HF (r=-0.27, p=0.04).
  
  
  
  CAN associates with DN lesions.
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Wheelock
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Mamta
authors.initials: M
authors.lastname: Jaiswal
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ.
authors.forename: Gudeta D
authors.initials: GD
authors.lastname: Fufaa
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Weil
authors.affiliation: Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Kevin V
authors.initials: KV
authors.lastname: Lemley
authors.affiliation: Southwest Kidney Institute, Phoenix, AZ.
authors.forename: Berne
authors.initials: B
authors.lastname: Yee
authors.affiliation: Department of Neurology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Eva
authors.initials: E
authors.lastname: Feldman
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Brosius
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ.
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.affiliation: Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ. Electronic address: rnelson@phx.niddk.nih.gov.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
mesh_terms: D000328:Adult; D001130:Arizona; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D002319:Cardiovascular System / Q000294:innervation / Q000503:physiopathology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D003925:Diabetic Angiopathies / Q000208:ethnology / Q000503:physiopathology; D058065:Diabetic Cardiomyopathies / Q000208:ethnology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000208:ethnology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007198:Indians, North American; D007668:Kidney / Q000294:innervation / Q000473:pathology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology*; D012598:Sclerosis; D012720:Severity of Illness Index
keywords: American Indians; Cardiovascular autonomic neuropathy; Diabetic nephropathy; Kidney biopsy; Type 2 diabetes