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Observational Study
. 2025 Feb;16(2):225-235.
doi: 10.1111/jdi.14348. Epub 2024 Nov 12.

Deterioration in ankle reflex is associated with a reduced estimated glomerular filtration rate in patients with type 2 diabetes: A retrospective observational cohort study

Taichi Muramatsu  1 , Daisuke Yamamuro  1 , Akifumi Kushiyama  1 , Takako Kikuchi  2
Affiliations
Observational Study

Deterioration in ankle reflex is associated with a reduced estimated glomerular filtration rate in patients with type 2 diabetes: A retrospective observational cohort study

Taichi Muramatsu et al. J Diabetes Investig. 2025 Feb.

Abstract

Aims/introduction: We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes.

Materials and methods: This was a single-center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan-Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR.

Results: The ankle reflex test results were as follows: normal, n = 678 (48.9%); decreased, n = 270 (19.5%); and absent, n = 439 (31.6%) patients. The median follow-up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16-2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76-3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors.

Conclusions: Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes.

Keywords: Diabetic neuropathies; Kidney diseases; Reflex.

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Conflict of interest statement

The authors declare no conflict of interest.

Approval of the research protocol: The present study was approved by the Committee of Ethics of the Institute for Medical Science, Asahi Life Foundation, Tokyo, Japan (approval number: 08702–6), in accordance with the principles of the Declaration of Helsinki; every effort was made to ensure patient anonymity.

Informed consent: N/A

Approval date of Registry and the Registration No. of the study/trial: N/A

Animal studies: N/A

Figures

Figure 1
Figure 1
Flowchart of inclusion and exclusion criteria. A total of 1,403 patients met the inclusion criteria. In the analysis for the primary outcome (40% loss of eGFR from baseline), 1,387 patients were included. In the analyses for secondary outcomes, 1,382 patients were included in the analysis for 30% loss of eGFR from baseline, while 1,240 patients were included in the analysis for eGFR <60 mL/min/1.73 m2. Cr, serum creatinine.
Figure 2
Figure 2
(a) Kaplan–Meier curves for 1,387 patients stratified by the findings of the ankle reflex examination (P‐value < 0.0001). (b) Kaplan–Meier curves for 1,308 patients stratified by the findings of the patellar reflex examination (P‐value < 0.0001). (c) Kaplan–Meier curves for 1,297 patients stratified by the presence of neuropathic symptoms (pain or numbness; P‐value = 0.19). (d) Kaplan–Meier curves for 953 patients stratified by the presence of vibration sensation abnormality (128‐Hz tuning fork ≤ 10 s; P‐value = 0.001). eGFR, estimated glomerular filtration rate.
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