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Abstract
Summary Background: One of the leading causes of terminal renal failure is diabetic nephropathy. The aim of this study was to determine the relationship between homocysteine levels and the biomarkers of renal function, inflammation and oxidative stress, as well as the incidence of macrovascular complications in patients with diabetic nephropathy. Methods: Sixty-four patients with diabetic nephropathy were included in this study. They were divided according to their homocysteine levels into two groups: hyperhomocysteinemic (HHcy, n=47) and normohomocysteinemic patients (NHCy, n=17). The re sults were compared to a control group (n=20) with normal renal function and without diabetes. Besides homocysteine, cystatine C, creatinine, urea, albuminuria, creatinine clearance, lipid status parameters, apolipoprotein A-I and B, lipo protein (a), CRP, fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macro vascular diabetic complications was also determined. Results: The results indicate that the level of renal dysfunction is greater in HHcy than in NHcy patients (p<0.05). In HHcy patients levels of oxLDL were also higher compared to NHcy patients (119.3±140.4 vs. 71.4±50.8 ng/mL, disp< 0.05) as well as fibrinogen levels (4.3±1.3 vs. 3.7±0.8 g/L, p<0.05). The in cidence of macrovascular complications is more frequent in HHcy than in NHcy patients (55.3. vs. 35.3 %, p>0.05), and in patients with macroalbuminuria compared to patients with microalbuminuria (65% vs. 39%, p<0.05). Conclusions: It can be concluded that HHcy is significantly present in patients with diabetic nephropathy, especially if there is greater reduction of renal function. Besides that, significantly higher concentrations of inflammatory (fibrinogen) and oxidative stress (oxLDL) markers were present in HHcy patients with diabetic nephropathy compared to NHcy patients.Therefore in diabetic nephropathy patients it is useful to regularly monitor the levels of homocysteine, as well as inflammatory and markers of oxidative stress.
Highlights
Diabetes mellitus (DM) type 2 is characterized by a significant rate of vascular complications [1], including diabetic nephropathy (DN), one of the leading causes of terminal renal failure
In order to assess the relationship between homocysteinemia and the biomarkers of inflammation, oxidative stress, functional renal status and the incidence of macrovascular complications of diabetes in DN patients, the subjects in this study were divided into two groups: with elevated (HHcy) and normal (NHcy) levels of homocysteine, and we evaluated creatinine clearance (CCr), cystatin C, albuminuria, lipid status parameters, apolipoprotein A-I and B, lipoprotein (a), levels of CRP, fibrinogen and oxidized LDL
All patients with diabetic nephropathy were examined in the relevant clinics of the Clinical Center of Vojvodina in order to determine the presence of other chronic complications (University Eye Clinic and Clinic for Endocrinology, Diabetes and Metabolic Diseases)
Summary
Diabetes mellitus (DM) type 2 is characterized by a significant rate of vascular complications [1], including diabetic nephropathy (DN), one of the leading causes of terminal renal failure. Besides that, in these patients there is a great incidence of cardiovascular diseases [2], especially if DN is present [3]. In type 2 DM Hcy level can be elevated, decreased or unchanged compared to a general population of adequate age [11,12,13]. Hyperglycemia itself leads to activation of trans-sulfuric enzymes and affects plasmatic Hcy levels [14]
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