Prognostic Value of Sudomotor Small-Fiber Function and Large Nerves for Accelerated Renal Decline in Type 2 Diabetes: A Real-World Cohort Study.
- 1Department of Endocrinology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- 2Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract
Aims
To evaluate the longitudinal prognostic value of small- and large-fiber peripheral nerve assessments for accelerated renal decline in patients with Type 2 diabetes (T2D).Methods
An initial cross-sectional analysis evaluated concurrent neuro-renal associations, while a subsequent longitudinal cohort assessed accelerated renal progression (eGFR loss > 3 mL/min/1.73 m²/year) using paired baseline and follow-up data. Prognostic predictors were selected via LASSO regression. Model utility was assessed using area under the curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA).Results
Cross-sectional sudomotor small-fiber dysfunction accurately mirrored concurrent renal impairment (β = 0.18, 95% CI: 0.10-0.26, p < 0.001). Longitudinally, ESCF demonstrated no independent prognostic value for accelerated renal decline, and its apparent longitudinal association with future eGFR was completely attenuated after adjusting for baseline renal function. LASSO regression retained right peroneal motor amplitude, serum albumin, platelet count, and SGLT2i use as robust prognostic factors. Notably, subgroup analyses revealed this large-nerve predictive capacity was significant primarily in patients with established DKD (p for interaction = 0.006). Incorporating this neurofunctional phenotype into standard clinical models yielded a modest AUC improvement but achieved a clinically relevant continuous NRI of 30.35%, successfully recalibrating risk profiles. DCA confirmed a superior net clinical benefit.Conclusion
A distinct prognostic dissociation exists within the diabetic neuro-renal axis. Sudomotor small-fiber dysfunction primarily reflects established microvascular impairment, whereas large motor nerve degeneration demonstrates independent prognostic value for future accelerated renal decline. Incorporating this neurofunctional phenotype into traditional clinical models yields substantial individualized risk reclassification, thereby potentially aiding in identifying high-risk individuals.
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BibTeX
@article{cai2026prognostic,
title = {{Prognostic Value of Sudomotor Small-Fiber Function and Large Nerves for Accelerated Renal Decline in Type 2 Diabetes: A Real-World Cohort Study.}},
author = {Qingyun Cai and Xiuqi Qiao and Sijia Fei and Yanxiang Luo and Lixin Guo and Qi Pan},
journal = {Journal of diabetes},
year = {2026},
month = oct,
doi = {10.1111/1753-0407.70286},
url = {https://europepmc.org/article/MED/42896873},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic Value of Sudomotor Small-Fiber Function and Large Nerves for Accelerated Renal Decline in Type 2 Diabetes: A Real-World Cohort Study.
AU - Qingyun Cai
AU - Xiuqi Qiao
AU - Sijia Fei
AU - Yanxiang Luo
AU - Lixin Guo
AU - Qi Pan
PY - 2026
DA - 2026/10/01
JO - Journal of diabetes
DO - 10.1111/1753-0407.70286
UR - https://europepmc.org/article/MED/42896873
AB - Aims To evaluate the longitudinal prognostic value of small- and large-fiber peripheral nerve assessments for accelerated renal decline in patients with Type 2 diabetes (T2D).Methods An initial cross-sectional analysis evaluated concurrent neuro-renal associations, while a subsequent longitudinal cohort assessed accelerated renal progression (eGFR loss > 3 mL/min/1.73 m²/year) using paired baseline and follow-up data. Prognostic predictors were selected via LASSO regression. Model utility was assessed using area under the curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA).Results Cross-sectional sudomotor small-fiber dysfunction accurately mirrored concurrent renal impairment (β = 0.18, 95% CI: 0.10-0.26, p < 0.001). Longitudinally, ESCF demonstrated no independent prognostic value for accelerated renal decline, and its apparent longitudinal association with future eGFR was completely attenuated after adjusting for baseline renal function. LASSO regression retained right peroneal motor amplitude, serum albumin, platelet count, and SGLT2i use as robust prognostic factors. Notably, subgroup analyses revealed this large-nerve predictive capacity was significant primarily in patients with established DKD (p for interaction = 0.006). Incorporating this neurofunctional phenotype into standard clinical models yielded a modest AUC improvement but achieved a clinically relevant continuous NRI of 30.35%, successfully recalibrating risk profiles. DCA confirmed a superior net clinical benefit.Conclusion A distinct prognostic dissociation exists within the diabetic neuro-renal axis. Sudomotor small-fiber dysfunction primarily reflects established microvascular impairment, whereas large motor nerve degeneration demonstrates independent prognostic value for future accelerated renal decline. Incorporating this neurofunctional phenotype into traditional clinical models yields substantial individualized risk reclassification, thereby potentially aiding in identifying high-risk individuals.
SN - 1753-0393
SN - 1753-0407
ER -