Cardiovascular autonomic neuropathy and incident diabetic kidney disease in patients with type 2 diabetes

We investigated the association between cardiovascular autonomic neuropathy (CAN) and incident diabetic kidney disease (DKD). This retrospective longitudinal study included 2,033 patients with type 2 diabetes (mean age 57.2 years, 57.4% male, and median diabetes duration 8.0 years), free of renal dysfunction or cardiovascular disease at initiation. Cardiovascular autonomic reflex tests were performed once at baseline, and CAN was defined as ≥ 2 abnormal parasympathetic test results. Urine ACR and eGFR were concurrently measured at baseline and every 3–6 months thereafter. Incident DKD was defined as the development of ACR ≥ 30 mg/g at two or more follow-up examinations or eGFR