Plasma Homocysteine Level And Its Correlation Between Heart And Renal Damage In Patients With Chronic Kidney Disease

Objective:Hyperhomocysteinemia(HHcy)is recognized as the risk factor for cardiovascular disease.However,it whether is linked to the progression of chronic kidney disease(CKD)is unclear.So the purpose of this study was to understand the prevalence of HHcy in patients with chronic kidney disease and its cardiac and renal damage,to explore the factors related to HHcy and the role of HHcy in heart and renal damage.Methods:Collect the clinical data of 192 patients with CKD in the inpatient department who visited the affiliated hospital of North Sichuan Medical College from January 1,2019 to October 31,2019.Patients were divided into the hyperhomocysteinemia and the normohomocysteinemia groups to compare their the general condition,laboratory indexes and cardiac and renal parameters.Multivariable linear regression analyses were used to evaluate the association between plasma homocystenine and cardiac and renal parameters.t-test,Mann-Whitney test,Chi-square(?2)test,Fisher's exact test,Spearman linear correlation analysis and Multivariable linear regression analyses were used to statistical analysis.Results:1.HHcy incidence:Among the 192 patients with chronic kidney disease,total hyperhomocysteinemia rate was 61.46%(118/192),the rate of hyperhomocysteinemia from CKD1 to CKD5 was 6.26%,33.33%,68.97%,91.18%,80%,respectively.There was no significant difference between the CKD4 and CKD5(P>0.05),and the difference between the other two periods was statistically significant(P<0.05).2.Comparision of general situation and laboratory indicators:the hyperhomocysteinemia rates of male and female patients are 69.31%and 52.75%,and men are more likely to get hyperhomocysteinemia than women(P<0.05).Patients with hyperhomocysteinemia had older age,higher smoking and drinking rate,and higher level of calcium×phosphate,blood urea nitrogen,serum creatinine,uric acid,serum cystatin C,PTH and clinic systolic blood pressure,lower level of hemoglobin,cholesterol and LDL-C compared with normohomocysteinemia(P<0.05).3.It is higher that the rate of renal insufficiency,left ventricular hypertrophy,diastolic dysfunction of hyperhomocysteinemia group than normohomocysteinemia group(renal insufficiency:90.68%VS 35.14%,P<0.05;left ventricular hypertrophy:56.38%VS 33.33%,P<0.05;diastolic dysfunction:77.70%VS 57.89%,P<0.05).Compared with the patients with normal homocysteine,the left ventricular mass index is higher(P<0.05),and the estimated glomerular filtration rate and E/A is lower in patients with hyperhomocysteinemia(P<0.05).4.Multivariable linear regression analysis showed estimated glomerular filtration rate isn't an independent risk factor for HHcy in paients with CKD(t=1.68,P=0.09).Blood urea nitrogen,hypersensitive C reactive protein and serum albumin could affect the increase of homocysteine level(B=0.46,t=5.57,P<0.01),(B=0.20,t=3.67,P<0.01),(B=0.26,t=0.13,P=0.04).5.Homocysteine was negatively correlated with eGFR(p=-0.59,P<0.01),and multiple linear regression analysis showed that homocysteine was an independent risk factor for renal insufficiency(B=-0.75,t=-3.96,P<0.01).homocysteine was positively correlated with LVMI(p=0.33,P<0.01)and negatively correlated with E/A(p=-0.23,P<0.01).Conclusion:1.The incidence of HHcy in patients with CKD was high,and the incidence of HHcy in this study was 61.46%.With the development of CKD,the incidence of hhcy increased.2.The decrease of eGFR wasn't an independent risk factor for affecting the increase of Hcy in patients with chronic kidney disease.The increase of Hcy was related to the metabolic changes of Hcy caused by microinflammation and malnutrition.3.Homocysteine is an independent risk factor for renal insufficiency.Homocysteine is closely related to heart and kidney damage in patients with CKD.