{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:00:44Z","timestamp":1792512044358,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>The aim of this study was to determine whether cardiac autonomic neuropathy (CAN) is an independent risk factor for kidney function decline in type 1 diabetes mellitus over a 15 year follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Eighty seven participants with type 1 diabetes and eGFR &gt;30 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      underwent cardiovascular autonomic reflex testing at baseline. Renal data were retrieved at 4 year intervals over 15 years. Stratification of participants into Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease progression prognostic risk was done by using eGFR and urinary albumin\/creatinine ratio (UACR). Longitudinal changes in eGFR and UACR were analysed using linear mixed-effects models with adjustment for potential confounders to determine whether CAN is an independent predictor of eGFR and UACR change over 15 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At baseline, higher KDIGO risk category was associated with increased severity of CAN (\n                      <jats:italic>r<\/jats:italic>\n                      =0.38,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001) and increase in UACR (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001) compared with the lower risk group. Participants with established CAN at baseline exhibited greater mean (SD) eGFR decline of 14.8 (21.6) ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      , compared with 3.1 (7.3) and 3.3 (7.4) ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      in the early stage and those without CAN (\n                      <jats:italic>p<\/jats:italic>\n                      =0.004). Mean (SD) increases in UACR were 0.4 (0.9), 11.3 (30.4) and 4 (8.9) mg\/mmol for no CAN, early CAN and established CAN (\n                      <jats:italic>p<\/jats:italic>\n                      =0.03), respectively. After adjusting for potential confounders, baseline CAN was independently associated with both accelerated eGFR decline (\n                      <jats:italic>p<\/jats:italic>\n                      =0.018) and greater increases in UACR (\n                      <jats:italic>p<\/jats:italic>\n                      =0.002) over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>CAN is an independent predictor of both accelerated eGFR decline and increased albuminuria in type 1 diabetes. The study also explored the relationship between CAN and KDIGO prognostic risk in diabetic kidney disease, demonstrating that increased severity of CAN is associated with higher KDIGO prognostic risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06818-y","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:39:51Z","timestamp":1785332391000},"page":"2983-2992","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac autonomic neuropathy predicts renal decline in type 1 diabetes mellitus: a 15 year follow-up study"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5372-0525","authenticated-orcid":false,"given":"Kywe Kywe","family":"Soe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misbah","family":"Oleolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2793-309X","authenticated-orcid":false,"given":"Mohummad","family":"Goonoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6164-2662","authenticated-orcid":false,"given":"Gordon","family":"Sloan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2425-9565","authenticated-orcid":false,"given":"Simon","family":"Heller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1190-1472","authenticated-orcid":false,"given":"Solomon","family":"Tesfaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8910-4735","authenticated-orcid":false,"given":"Jefferson L. B.","family":"Marques","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3374-3973","authenticated-orcid":false,"given":"Steven","family":"Sourbron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7426-1105","authenticated-orcid":false,"given":"Dinesh","family":"Selvarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"6818_CR1","unstructured":"Varghese RT, Jialal I, Doerr C (2022) Diabetic nephropathy (nursing). StatPearls. Treasure Island (FL): StatPearls Publishing"},{"key":"6818_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00592-022-01958-0","volume":"60","author":"D Patoulias","year":"1958","unstructured":"Patoulias D, Katsimardou A, Fragakis N, Christodoulos P, Doumas M (1958) Effect of SGLT-2 inhibitors on cardiac autonomic function in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Acta Diabetol 60:1\u20138. https:\/\/doi.org\/10.1007\/s00592-022-01958-0","journal-title":"Acta Diabetol"},{"key":"6818_CR3","doi-asserted-by":"publisher","unstructured":"DeFronzo RA, Reeves WB, Awad AS (2021) Pathophysiology of diabetic kidney disease: impact of SGLT2 inhibitors. Nat Rev Nephrol 17(5):319\u201334. https:\/\/doi.org\/10.1038\/s41581-021-00393-8","DOI":"10.1038\/s41581-021-00393-8"},{"key":"6818_CR4","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.36438","author":"C Yarlagadda","year":"2023","unstructured":"Yarlagadda C, Abutineh M, Reddy AJ et al (2023) An investigation on the efficacy of glucagon-like peptide 1 receptor agonists drugs in reducing urine albumin-to-creatinine ratio in patients with type 2 diabetes: a potential treatment for diabetic nephropathy. Cureus. https:\/\/doi.org\/10.7759\/cureus.36438","journal-title":"Cureus"},{"key":"6818_CR5","doi-asserted-by":"publisher","DOI":"10.1080\/00325481.2022.2060598","author":"E Lerma","year":"2023","unstructured":"Lerma E, White WB, Bakris G (2023) Effectiveness of nonsteroidal mineralocorticoid receptor antagonists in patients with diabetic kidney disease. Postgrad Med. https:\/\/doi.org\/10.1080\/00325481.2022.2060598","journal-title":"Postgrad Med"},{"issue":"10","key":"6818_CR6","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1056\/NEJMoa2512854","volume":"394","author":"HJL Heerspink","year":"2026","unstructured":"Heerspink HJL, Birkenfeld AL, Cherney DZI et al (2026) Finerenone in type 1 diabetes and chronic kidney disease. N Engl J Med 394(10):947\u201357. https:\/\/doi.org\/10.1056\/NEJMoa2512854","journal-title":"N Engl J Med"},{"key":"6818_CR7","doi-asserted-by":"publisher","first-page":"110908","DOI":"10.1016\/j.diabres.2023.110908","volume":"204","author":"HJL Heerspink","year":"2023","unstructured":"Heerspink HJL, Birkenfeld AL, Cherney DZI et al (2023) Rationale and design of a randomised phase III registration trial investigating finerenone in participants with type 1 diabetes and chronic kidney disease: the FINE-ONE trial. Diabetes Res Clin Pract 204:110908. https:\/\/doi.org\/10.1016\/j.diabres.2023.110908","journal-title":"Diabetes Res Clin Pract"},{"issue":"5","key":"6818_CR8","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1681\/ASN.0000000540","volume":"36","author":"VS Sridhar","year":"2025","unstructured":"Sridhar VS, Odutayo A, Garg S et al (2025) Efficacy and safety of sotagliflozin in patients with type 1 diabetes and CKD. J Am Soc Nephrol 36(5):890\u2013900. https:\/\/doi.org\/10.1681\/ASN.0000000540","journal-title":"J Am Soc Nephrol"},{"issue":"11","key":"6818_CR9","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1016\/S2213-8587(17)30308-X","volume":"5","author":"P Dandona","year":"2017","unstructured":"Dandona P, Mathieu C, Phillip M et al (2017) Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes (DEPICT-1): 24 week results from a multicentre, double-blind, phase 3, randomised controlled trial. Lancet Diabetes Endocrinol 5(11):864\u2013876. https:\/\/doi.org\/10.1016\/S2213-8587(17)30308-X","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"9","key":"6818_CR10","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.2337\/dc18-0623","volume":"41","author":"C Mathieu","year":"2018","unstructured":"Mathieu C, Dandona P, Gillard P et al (2018) Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes (the DEPICT-2 study): 24-week results from a randomized controlled trial. Diabetes Care 41(9):1938\u20131946. https:\/\/doi.org\/10.2337\/dc18-0623","journal-title":"Diabetes Care"},{"issue":"5","key":"6818_CR11","doi-asserted-by":"publisher","first-page":"773","DOI":"10.2337\/diacare.16.5.773","volume":"16","author":"G Sundkvist","year":"1993","unstructured":"Sundkvist G, Lilja B (1993) Autonomic neuropathy predicts deterioration in glomerular filtration rate in patients with IDDM. Diabetes Care 16(5):773\u20139. https:\/\/doi.org\/10.2337\/diacare.16.5.773","journal-title":"Diabetes Care"},{"issue":"2\u20133","key":"6818_CR12","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/S0167-5273(02)00346-7","volume":"86","author":"AJ Burger","year":"2002","unstructured":"Burger AJ, D\u2019Elia JA, Weinrauch LA, Lerman I, Gaur A (2002) Marked abnormalities in heart rate variability are associated with progressive deterioration of renal function in type I diabetic patients with overt nephropathy. Int J Cardiol 86(2\u20133):281\u20137. https:\/\/doi.org\/10.1016\/S0167-5273(02)00346-7","journal-title":"Int J Cardiol"},{"issue":"3 I","key":"6818_CR13","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/S0895-7061(97)00472-X","volume":"11","author":"LA Weinrauch","year":"1998","unstructured":"Weinrauch LA, Kennedy FP, Gleason RE, Keough J, D\u2019Elia JA (1998) Relationship between autonomic function and progression of renal disease in diabetic proteinuria: clinical correlations and implications for blood pressure control. Am J Hypertens 11(3 I):302\u20138. https:\/\/doi.org\/10.1016\/S0895-7061(97)00472-X","journal-title":"Am J Hypertens"},{"issue":"7","key":"6818_CR14","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.2215\/CJN.11441114","volume":"10","author":"S Orlov","year":"2015","unstructured":"Orlov S, Cherney DZI, Pop-Busui R et al (2015) Cardiac autonomic neuropathy and early progressive renal decline in patients with nonmacroalbuminuric type 1 diabetes. Clin J Am Soc Nephrol 10(7):1136\u201344. https:\/\/doi.org\/10.2215\/CJN.11441114","journal-title":"Clin J Am Soc Nephrol"},{"issue":"5","key":"6818_CR15","doi-asserted-by":"publisher","first-page":"751","DOI":"10.2337\/db23-0247","volume":"73","author":"Y Tang","year":"2024","unstructured":"Tang Y, Ang L, Jaiswal M et al (2024) Cardiovascular autonomic neuropathy and risk of kidney function decline in type 1 and type 2 diabetes: findings from the PERL and ACCORD cohorts. Diabetes 73(5):751\u2013762. https:\/\/doi.org\/10.2337\/db23-0247","journal-title":"Diabetes"},{"issue":"Suppl 1","key":"6818_CR16","doi-asserted-by":"publisher","first-page":"S69","DOI":"10.3346\/jkms.2009.24.S1.S69","volume":"24","author":"YK Kim","year":"2009","unstructured":"Kim YK, Lee JE, Kim YG et al (2009) Cardiac autonomic neuropathy as a predictor of deterioration of the renal function in normoalbuminuric, normotensive patients with type 2 diabetes mellitus. J Korean Med Sci 24(Suppl 1):S69. https:\/\/doi.org\/10.3346\/jkms.2009.24.S1.S69","journal-title":"J Korean Med Sci"},{"issue":"1","key":"6818_CR17","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1111\/jdi.13625","volume":"13","author":"T Muramatsu","year":"2022","unstructured":"Muramatsu T, Takahashi M, Kakinuma R et al (2022) Decline in renal function associated with cardiovascular autonomic neuropathy positively coordinated with proteinuria in patients with type\u00a02 diabetes. J Diabetes Investig 13(1):102\u2013111. https:\/\/doi.org\/10.1111\/jdi.13625","journal-title":"J Diabetes Investig"},{"key":"6818_CR18","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1294","author":"R Pop-Busui","year":"2010","unstructured":"Pop-Busui R (2010) Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. https:\/\/doi.org\/10.2337\/dc09-1294","journal-title":"Diabetes Care"},{"issue":"6","key":"6818_CR19","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1530\/eje.0.1350683","volume":"135","author":"PT Monteagudo","year":"1996","unstructured":"Monteagudo PT, N\u00f3brega JC, Cezarini PR et al (1996) Altered blood pressure profile, autonomic neuropathy and nephropathy in insulin-dependent diabetic patients. Eur J Endocrinol 135(6):683\u20138. https:\/\/doi.org\/10.1530\/eje.0.1350683","journal-title":"Eur J Endocrinol"},{"key":"6818_CR20","doi-asserted-by":"publisher","unstructured":"Spallone V, Gambardella S, Maiello MR, Barini A, Frontoni S, Menzinger G\u00a0(1994) Relationship between autonomic neuropathy, 24-h blood pressure profile, and nephropathy in normotensive IDDM patients.\u00a0Diabetes Care 17(6):578\u2013584. https:\/\/doi.org\/10.2337\/diacare.17.6.578","DOI":"10.2337\/diacare.17.6.578"},{"issue":"9","key":"6818_CR21","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.2337\/diacare.23.9.1369","volume":"23","author":"YM Smulders","year":"2000","unstructured":"Smulders YM, Jager A, Gerritsen J et al (2000) Cardiovascular autonomic function is associated with (micro-)albuminuria in elderly caucasian subjects with impaired glucose tolerance or type 2 diabetes: the Hoorn study. Diabetes Care 23(9):1369\u201374. https:\/\/doi.org\/10.2337\/diacare.23.9.1369","journal-title":"Diabetes Care"},{"issue":"1","key":"6818_CR22","doi-asserted-by":"publisher","first-page":"e002289","DOI":"10.1136\/bmjdrc-2021-002289","volume":"9","author":"T Bjerre-Christensen","year":"2021","unstructured":"Bjerre-Christensen T, Winther SA, Tofte N et al (2021) Cardiovascular autonomic neuropathy and the impact on progression of diabetic kidney disease in type 1 diabetes. BMJ Open Diabetes Res Care 9(1):e002289. https:\/\/doi.org\/10.1136\/bmjdrc-2021-002289","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"4","key":"6818_CR23","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1136\/hrt.55.4.348","volume":"55","author":"IA O\u2019Brien","year":"1986","unstructured":"O\u2019Brien IA, O\u2019Hare P, Corrall RJM (1986) Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function. Br Heart J 55(4):348\u201354. https:\/\/doi.org\/10.1136\/hrt.55.4.348","journal-title":"Br Heart J"},{"issue":"4","key":"6818_CR24","doi-asserted-by":"publisher","first-page":"A1","DOI":"10.1016\/s0085-2538(24)00110-8","volume":"105","author":"PE Stevens","year":"2024","unstructured":"Stevens PE, Ahmed SB, Carrero JJ et al (2024) The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 clinical practice guideline for the evaluation and management of chronic kidney disease (CKD). Kidney Int 105(4):A1. https:\/\/doi.org\/10.1016\/s0085-2538(24)00110-8","journal-title":"Kidney Int"},{"key":"6818_CR25","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.02.337","author":"AS Levey","year":"2010","unstructured":"Levey AS, Stevens LA (2010) Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. https:\/\/doi.org\/10.1053\/j.ajkd.2010.02.337","journal-title":"Am J Kidney Dis"},{"issue":"2","key":"6818_CR26","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1681\/ASN.2008030292","volume":"20","author":"EC Witte","year":"2009","unstructured":"Witte EC, Heerspink HJL, De Zeeuw D, Bakker SJL, De Jong PE, Gansevoort R (2009) First morning voids are more reliable than spot urine samples to assess microalbuminuria. J Am Soc Nephrol 20(2):436\u201343. https:\/\/doi.org\/10.1681\/ASN.2008030292","journal-title":"J Am Soc Nephrol"},{"issue":"6","key":"6818_CR27","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1053\/j.ajkd.2014.08.017","volume":"64","author":"LA Inker","year":"2014","unstructured":"Inker LA, Lambers Heerspink HJ, Mondal H et al (2014) GFR decline as an alternative end point to kidney failure in clinical trials: a meta-analysis of treatment effects from 37 randomized trials. Am J Kidney Dis 64(6):848\u201359. https:\/\/doi.org\/10.1053\/j.ajkd.2014.08.017","journal-title":"Am J Kidney Dis"},{"issue":"4","key":"6818_CR28","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/sj.jhh.1001170","volume":"15","author":"V Spallone","year":"2001","unstructured":"Spallone V, Maiello MR, Cicconetti E et al (2001) Factors determining the 24-h blood pressure profile in normotensive patients with type 1 and type 2 diabetes. J Hum Hypertens 15(4):239\u201346. https:\/\/doi.org\/10.1038\/sj.jhh.1001170","journal-title":"J Hum Hypertens"},{"issue":"8","key":"6818_CR29","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1111\/j.1464-5491.2004.01255.x","volume":"21","author":"A Fors\u00e9n","year":"2004","unstructured":"Fors\u00e9n A, Kangro M, Sterner G et al (2004) A 14-year prospective study of autonomic nerve function in type 1 diabetic patients: association with nephropathy. Diabet Med 21(8):852\u20138. https:\/\/doi.org\/10.1111\/j.1464-5491.2004.01255.x","journal-title":"Diabet Med"},{"issue":"1","key":"6818_CR30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.2337\/dc06-0793","volume":"30","author":"AM Maguire","year":"2007","unstructured":"Maguire AM, Craig ME, Craighead A et al (2007) Autonomic nerve testing predicts the development of complications: a 12-year follow-up study. Diabetes Care 30(1):77\u201382. https:\/\/doi.org\/10.2337\/dc06-0793","journal-title":"Diabetes Care"},{"key":"6818_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2022.09.002","author":"S Williams","year":"2022","unstructured":"Williams S, Raheim SA, Khan MI et al (2022) Cardiac autonomic neuropathy in type 1 and 2 diabetes: epidemiology, pathophysiology, and management. Clin Ther. https:\/\/doi.org\/10.1016\/j.clinthera.2022.09.002","journal-title":"Clin Ther"},{"key":"6818_CR32","doi-asserted-by":"publisher","first-page":"109181","DOI":"10.1016\/j.diabres.2021.109181","volume":"184","author":"J Eun Jun","year":"2022","unstructured":"Eun Jun J, Sun Choi M, Hyeon Kim J (2022) Cardiovascular autonomic neuropathy and incident diabetic kidney disease in patients with type 2 diabetes. Diabetes Res Clin Pract 184:109181. https:\/\/doi.org\/10.1016\/j.diabres.2021.109181","journal-title":"Diabetes Res Clin Pract"},{"issue":"4","key":"6818_CR33","doi-asserted-by":"publisher","first-page":"972","DOI":"10.2337\/diacare.27.4.972","volume":"27","author":"A Moran","year":"2004","unstructured":"Moran A, Palmas W, Field L et al (2004) Cardiovascular autonomic neuropathy is associated with microalbuminuria in older patients with type 2 diabetes. Diabetes Care 27(4):972\u20137. https:\/\/doi.org\/10.2337\/diacare.27.4.972","journal-title":"Diabetes Care"},{"issue":"5","key":"6818_CR34","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1111\/j.1464-5491.1986.tb00786.x","volume":"3","author":"PH Winocour","year":"1986","unstructured":"Winocour PH, Dhar H, Anderson DC (1986) The relationship between autonomic neuropathy and urinary sodium and albumin excretion in insulin-treated diabetics. Diabet Med 3(5):436\u201340. https:\/\/doi.org\/10.1111\/j.1464-5491.1986.tb00786.x","journal-title":"Diabet Med"},{"issue":"5","key":"6818_CR35","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/13510002.2016.1173326","volume":"22","author":"SB Fadaee","year":"2017","unstructured":"Fadaee SB, Beetham KS, Howden EJ, Stanton T, Isbel NM, Coombes JS (2017) Oxidative stress is associated with decreased heart rate variability in patients with chronic kidney disease. Redox Rep 22(5):197\u2013204. https:\/\/doi.org\/10.1080\/13510002.2016.1173326","journal-title":"Redox Rep"},{"issue":"5","key":"6818_CR36","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1038\/s41591-019-0415-5","volume":"25","author":"MA Niewczas","year":"2019","unstructured":"Niewczas MA, Pavkov ME, Skupien J et al (2019) A signature of circulating inflammatory proteins and development of end-stage renal disease in diabetes. Nat Med 25(5):805\u2013813. https:\/\/doi.org\/10.1038\/s41591-019-0415-5","journal-title":"Nat Med"},{"issue":"12","key":"6818_CR37","doi-asserted-by":"publisher","first-page":"1556","DOI":"10.2337\/diab.39.12.1556","volume":"39","author":"TB Wiegmann","year":"1990","unstructured":"Wiegmann TB, Herron KG, Chonko AM, Macdougall ML, Moore WV (1990) Recognition of hypertension and abnormal blood pressure burden with ambulatory blood pressure recordings in type I diabetes mellitus. Diabetes 39(12):1556\u201360. https:\/\/doi.org\/10.2337\/diab.39.12.1556","journal-title":"Diabetes"},{"issue":"10","key":"6818_CR38","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1038\/hr.2010.130","volume":"33","author":"V Dauphinot","year":"2010","unstructured":"Dauphinot V, Gosse P, Kossovsky MP et al (2010) Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern. Hypertens Res 33(10):1032\u20137. https:\/\/doi.org\/10.1038\/hr.2010.130","journal-title":"Hypertens Res"},{"issue":"11","key":"6818_CR39","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1111\/dom.14798","volume":"24","author":"M Chiriac\u00f2","year":"2022","unstructured":"Chiriac\u00f2 M, Sacchetta L, Forotti G et al (2022) Prognostic value of 24-hour ambulatory blood pressure patterns in diabetes: a 21-year longitudinal study. Diabetes Obes Metab 24(11):2127\u20132137. https:\/\/doi.org\/10.1111\/dom.14798","journal-title":"Diabetes Obes Metab"},{"issue":"1","key":"6818_CR40","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1186\/s12882-020-01901-x","volume":"21","author":"KM Gooding","year":"2020","unstructured":"Gooding KM, Lienczewski C, Papale M et al (2020) Prognostic imaging biomarkers for diabetic kidney disease (iBEAt): study protocol. BMC Nephrol 21(1):242. https:\/\/doi.org\/10.1186\/s12882-020-01901-x","journal-title":"BMC Nephrol"},{"key":"6818_CR41","doi-asserted-by":"publisher","unstructured":"Lauritzen T, Borch-Johnsen K, Davies MJ et al (2013) Screening for diabetes: what do the results of the ADDITION trial mean for clinical practice? Diabetes Manag 3(5). https:\/\/doi.org\/10.2217\/dmt.13.40","DOI":"10.2217\/dmt.13.40"},{"issue":"10","key":"6818_CR42","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1007\/s40266-020-00796-5","volume":"37","author":"G Rivasi","year":"2020","unstructured":"Rivasi G, Rafanelli M, Mossello E, Brignole M, Ungar A (2020) Drug-related orthostatic hypotension: beyond anti-hypertensive medications. Drugs Aging 37(10):725\u2013738. https:\/\/doi.org\/10.1007\/s40266-020-00796-5","journal-title":"Drugs Aging"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06818-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-026-06818-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-026-06818-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:16:38Z","timestamp":1788441398000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-026-06818-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["6818"],"URL":"https:\/\/doi.org\/10.1007\/s00125-026-06818-y","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"assertion":[{"value":"29 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Parts of this work are derived from the PhD thesis of K. K. Soe, titled \u2018Impact of cardiac autonomic neuropathy on diabetic kidney disease: assessment by MRI.\u2019 In addition, preliminary findings from this study were previously presented in abstract form at the 60th Annual Meeting of the EASD 2024 (oral presentation: \u2018Cardiac autonomic neuropathy: an independent risk factor for renal decline in diabetic kidney disease\u2019).","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The datasets generated and\/or analysed during the current study are not publicly available due to patient confidentiality and institutional data protection policies but are available from the corresponding author on reasonable request, subject to appropriate approvals.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"KKS was a doctoral student working on a project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement no. 115974. The JU receives support from the European Union\u2019s Horizon 2020 research and innovation program and EFPIA and Breakthrough T1D (formerly known as JDRF). This study was funded by Diabetes UK and the European Foundation for the Study of Diabetes.","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"DS is a member of the editorial board of\n                      Diabetologia\n                      . The other authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"All authors made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data, were involved in drafting the article or revising it critically for important intellectual content, and gave final approval of the version to be published. KKS is the guarantor of this work and is responsible for the integrity of the work as a whole. The guarantor accepts full responsibility for the work and\/or the conduct of the study, had access to the data, and controlled the decision to publish.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}