Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2025; 16(4): 101966
Published online Apr 15, 2025. doi: 10.4239/wjd.v16.i4.101966
Increased blood urea nitrogen levels and compromised peripheral nerve function in patients with type 2 diabetes
Rui Wang, Yu-Xian Xu, Feng Xu, Chun-Hua Wang, Li-Hua Zhao, Li-Hua Wang, Wei-Guan Chen, Xue-Qin Wang, Cheng-Wei Duan, Jian-Bin Su
Rui Wang, Yu-Xian Xu, Feng Xu, Chun-Hua Wang, Li-Hua Zhao, Xue-Qin Wang, Jian-Bin Su, Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Li-Hua Wang, Department of Nursing, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Wei-Guan Chen, Department of Rehabilitation, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Cheng-Wei Duan, Medical Research Center, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Co-corresponding authors: Cheng-Wei Duan and Jian-Bin Su.
Author contributions: Wang R and Xu YX contributed significantly to the study design, patient recruitment, collection of demographic data and medical history, biochemical and urinary indicator testing, electromyography for all participants, peripheral nerve function assessment, and statistical analysis for data interpretation; Wang R was responsible for drafting the initial manuscript and revising it in response to feedback from co-authors, peer reviewers, and editors; Xu F, Wang CH, Zhao LH, and Wang LH assisted in the collection of demographic data and medical history as well as the analysis of biochemical and urinary indicators; Wang LH also contributed to securing funding and interpreting the study’s findings; Chen WG contributed to the study design and conducted a critical review of the manuscript; Wang XQ was responsible for reviewing the manuscript and overseeing the study process; All authors participated in the review and approval of the final version of the manuscript; Su JB initiated a series of studies on diabetic peripheral neuropathy. The conceptualization and design of the current study’s protocol were collaboratively undertaken by Duan CW and Su JB, who also assumed responsibility for securing funding, data interpretation, manuscript review, and overall study supervision, thereby qualifying as the co-corresponding authors of this manuscript.
Supported by the Social Development Projects of Nantong, No. MS12019019, No. HS2022004 and No. MS2023083; the Medical Research Project of the Jiangsu Health Commission, No. Z2022058; and the National Natural Science Foundation of China, No. 32101027.
Institutional review board statement: This study received evaluation and approval from the Ethics Review Board of Nantong First People’s Hospital, under the reference number 2017XJS008.
Informed consent statement: All participants provided informed consent to take part in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have reviewed the STROBE Statement checklist and have prepared and revised the manuscript in accordance with its guidelines.
Data sharing statement: It is reasonable to request that the principal investigators make the data available for this study at sujbzjx@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Bin Su, MD, Assistant Professor, Department of Endocrinology, The Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. sujbzjx@163.com
Received: October 7, 2024
Revised: December 14, 2024
Accepted: January 9, 2025
Published online: April 15, 2025
Processing time: 148 Days and 3.8 Hours
Abstract
BACKGROUND

Increased blood urea nitrogen (BUN) levels have been demonstrated to be associated with broader metabolic disturbances and the incidence of type 2 diabetes (T2D), potentially playing a role in the development of diabetic complications, including diabetic peripheral neuropathy.

AIM

To examine the relationship between BUN levels and peripheral nerve function in patients with T2D.

METHODS

This observational study involved the systematic recruitment of 585 patients with T2D for whom BUN levels and estimated glomerular filtration rate were measured. Electromyography was used to assess peripheral motor and sensory nerve function in all patients, and overall composite Z-scores were subsequently calculated for nerve latency, amplitude, and conduction velocity (NCV) across the median, ulnar, common peroneal, posterior tibial, superficial peroneal, and sural nerves.

RESULTS

Across the quartiles of BUN levels, the overall composite Z-score for latency (F = 38.996, P for trend < 0.001) showed a significant increasing trend, whereas the overall composite Z-scores for amplitude (F = 50.972, P for trend < 0.001) and NCV (F = 30.636, P for trend < 0.001) exhibited a significant decreasing trend. Moreover, the BUN levels were closely correlated with the latency, amplitude, and NCV of each peripheral nerve. Furthermore, multivariate linear regression analysis revealed that elevated BUN levels were linked to a higher overall composite Z-score for latency (β = 0.166, t = 3.864, P < 0.001) and lower overall composite Z-scores for amplitude (β = -0.184, t = -4.577, P < 0.001) and NCV (β = -0.117, t = -2.787, P = 0.006) independent of the estimated glomerular filtration rate and other clinical covariates. Additionally, when the analysis was restricted to sensory or motor nerves, elevated BUN levels remained associated with sensory or motor peripheral nerve dysfunction.

CONCLUSION

Increased BUN levels were independently associated with compromised peripheral nerve function in patients with T2D.

Keywords: Blood urea nitrogen; Metabolic disturbance; Peripheral nerve function; Electromyography; Type 2 diabetes

Core Tip: Blood urea nitrogen (BUN) is a well-established biomarker utilized in clinical diagnostic evaluations. When renal function is relatively normal, an increase in BUN may indicate a negative nitrogen balance, underlying metabolic disorders, and potential adverse outcomes. In the present study, our findings indicated that increased BUN levels were independently associated with compromised peripheral nerve function in patients with type 2 diabetes and may serve as a potential risk factor for peripheral nerve dysfunction in these patients. Future interventions to lower BUN levels by improving nutritional status and balancing protein metabolism may alleviate peripheral nerve dysfunction in patients with type 2 diabetes.