High Prevalence of Hyperhomocysteinemia and Its Association with Target Organ Damage in Chinese Patients with Chronic Kidney Disease

Zengchun Ye,Qunzi Zhang,Hui Peng,Tanqi Lou,Jun Zhang,Yan Li,Cheng Wang,Xinxin Ma

doi:10.3390/nu8100645

Abstract

Hyperhomocysteinemia (HHcy) is recognized as a risk factor for cardiovascular disease. However, the prevalence of HHcy and its role in association with target organ damage in patients with chronickidney disease (CKD) are not well understood. This cross-sectional study included 1042 CKD patients who were admitted to our hospital. Patients were divided into two groups: hyperhomocysteinemia and normohomocysteinemia. Multivariable linear regression analyses were used to evaluate the association between plasma homocysteine and renal/cardiovascular parameters. The prevalence of HHcy in patients with CKD was 52.78%, and the prevalence in CKD stage 1, stage 2, stage 3, stage 4 and stage 5 patients was 10.73%, 29.22%, 58.71%, 75.23% and 83.75%, respectively. Patients with HHcy had higher incidences of renal damage, left ventricular hypertrophy, left ventricular diastolic dysfunction and abnormal carotid intima-media thickness compared with patients with normohomocysteinemia (p < 0.05), while multivariable linear regression analyses showed plasma homocysteine was only associated with the estimated glomerular filtration rate (eGFR). eGFR, uric acid, albumin, gender, hemoglobin and calcium×phosphate were associated with levels of plasma homocysteine in these CKD patients. The prevalence of HHcy in Chinese patients with CKD was high, and serum homocysteine levels were associated with impaired renal function in these patients.

Highlights

The rising prevalence of chronic kidney disease (CKD) has become a large public health challenge in China
Patients with HHcywere of older age; had a longer course; a higher prevalence of diabetes mellitus; were current smokers; had lower hemoglobin, proteinuria, cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and urinary sodium excretion; and had higher clinic systolic blood pressure, serum albumin, intact parathyroid hormone (iPTH), calcium×phosphate, uric acid, serum cystatin C, blood urea nitrogen and serum creatinine compared with subjects with normohomocysteinemia (p < 0.05) (Table 1)
All variables with significant associations were included in the multivariable regression analysis. In this cross-sectional study, we investigated the prevalence of HHcy in Chinese chronickidney disease (CKD) patients

Summary

Introduction

The rising prevalence of chronic kidney disease (CKD) has become a large public health challenge in China. Patients with CKD have the higher risk of cardiovascular disease (CVD), and CVD is the first cause of morbidity and mortality in these patients [2]. Exploring risk factors for CVD in patients with CKD is very important. Multiple studies have reported that decreasing the estimated glomerular filtration rate (eGFR) and increasing albuminuria are independent predictors of adverse cardiovascular outcomes in both community-based populations and in patients at high cardiovascular risk [3,4,5]. Recent studies have confirmed that traditional risk factors such as hypertension, smoking, diabetes and dyslipidemia are highly prevalent in CVD populations with

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