Vitamin D and cardiovascular autonomic neuropathy in type 2 diabetes mellitus according to diabetic kidney disease stage.
Cardiovascular autonomic neuropathy (CAN) may be associated with other diabetes mellitus-related complications. In addition, lower vitamin D (VD) levels have been associated with diabetic kidney disease (DKD) and diabetic neuropathy. We evaluated the relationship between serum VD and CAN in patients with type 2 Diabetes Mellitus (T2DM) in early and advanced stages of DKD.
Seventy-six T2DM patients, 28 in early DKD stage (urine albumin to creatinine ratio (UACR)): 30 to 299 mg/g - group 1), and 48 in advanced DKD stage (UACR ≥300 mg/g - group 2), participated.
In group 1, prevalence of CAN was 46% versus 75% in group 2 (p=0.01). 25(OH)D was lower in group 2 (26.3 ± 9.8 vs 30.0 ± 8.0; p<0.05) and, in this group, those with CAN vs without CAN showed lower 25(OH)D (27.8 ± 8.3 vs 32 ± 6.3; p<0.05). Only in group 2, patients with VD deficiency (<no><20</no> ng/ml) vs normal, showed worse CAN parameters, particularly VLF (65.5 (46-104) vs 309 (106.5-682.5), p<0.01), SDNN (10.5 (8-17.5) vs 28.5 (13-48), p<0.05) and Valsalva Maneuver (1.12 ± 0.04 vs 1.30 ± 0.21, p<0.05). We have found a correlation between VD concentration and CAN prevalence (r = -0.3, p<0.05). Logistic regression showed that VD concentration <no><20</no> ng/ml increased 24 times the chance of abnormal VLF (R²: 0.38; OR: 24.1; 95% (CI: 2.6-222); p<0.01).
To our knowledge, this is the first study to demonstrate an association between lower VD and CAN in T2DM and advanced DKD.
Seventy-six T2DM patients, 28 in early DKD stage (urine albumin to creatinine ratio (UACR)): 30 to 299 mg/g - group 1), and 48 in advanced DKD stage (UACR ≥300 mg/g - group 2), participated.
In group 1, prevalence of CAN was 46% versus 75% in group 2 (p=0.01). 25(OH)D was lower in group 2 (26.3 ± 9.8 vs 30.0 ± 8.0; p<0.05) and, in this group, those with CAN vs without CAN showed lower 25(OH)D (27.8 ± 8.3 vs 32 ± 6.3; p<0.05). Only in group 2, patients with VD deficiency (<no><20</no> ng/ml) vs normal, showed worse CAN parameters, particularly VLF (65.5 (46-104) vs 309 (106.5-682.5), p<0.01), SDNN (10.5 (8-17.5) vs 28.5 (13-48), p<0.05) and Valsalva Maneuver (1.12 ± 0.04 vs 1.30 ± 0.21, p<0.05). We have found a correlation between VD concentration and CAN prevalence (r = -0.3, p<0.05). Logistic regression showed that VD concentration <no><20</no> ng/ml increased 24 times the chance of abnormal VLF (R²: 0.38; OR: 24.1; 95% (CI: 2.6-222); p<0.01).
To our knowledge, this is the first study to demonstrate an association between lower VD and CAN in T2DM and advanced DKD.
Authors
FelĂcio FelĂcio, Chambouleyron Chambouleyron, Nascimento Nascimento, Fernandes Fernandes, Ruivo Ruivo, Hupp Hupp, Silva Silva, de Queiroz de Queiroz, de Melo de Melo, de Souza de Souza, Dos Santos Dos Santos, de Moraes de Moraes, Barros Barros, Pinheiro Pinheiro, do Carmo do Carmo, Lobo Lobo, Piani Piani, Motta Motta, Dos Reis Dos Reis, Leal Leal, de Figueiredo de Figueiredo, FelĂcio FelĂcio
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