Study Of The Correlation Between Serum Homocysteine Level And The Stages Of Type 2 Diabetic Kidney Disease

Background and Objective:Diabetic kidney disease(DKD)is a major chronic complication of type 2diabetes mellitus(T2DM)and one of the main causes of end-stage renal disease.Hypertension and hyperglycemia are the main factors for the progress of DKD.However,even if the prevalence of DKD is reduced after intensive hypoglycemic and reasonable blood pressure reduction in patients with diabetes,the growth rate of DKD and its economic burden in the past 10 years are still very significant,therefore,it is important to identify other factors that may affect the progress of DKD.Homocysteine(Hcy)is a sulfur-containing amino acid that can be observed in patients with renal insufficiency.DKD staging is a way to quantify the severity of DKD.The purpose of this study is to explore the correlation between serum Hcy level and the stages of type 2 diabetic kidney disease.Method:Collected data of 300 patients with T2 DM who were hospitalized in the Department of Endocrinology and Metabolism of the Second Affiliated Hospital of Nanchang University from March 2018 to January 2020,including 50 patients in simple-T2 DM group and 250 patients in DKD group.According to the Chronic Kidney Disease(CKD)staging criteria and albuminuria staging criteria of “Chinese Clinical Guidelines for the Prevention and Treatment of Diabetic Kidney Diseases”,DKD group was devided into CKD stage 1(n = 50),CKD stage 2(n = 50),CKD stage 3(n = 50),CKD stage 4(n = 50),CKD stage 5(n = 50)and stage A1(n = 69),stage A2(n = 91),stage A3(n = 90)respectively.Compare the general data,glucose and lipid metabolism indexes,renal function and related indexes,homocysteine(Hcy)and related indexes,and the incidence of hyperhomocysteinemia(HHcys)between DKD subgroups and T2 DM group.Analyze the correlation between the above general data and clinical indicators with Hcy level,CKD stages,and albuminuria stages.Multiple logistic regression analysis was used to explore the effects of Hcy on the development of CKD stages and albuminuria stages in T2 DM patients.Results:1)The level of Hcy and the prevalence of HHcys increased linearly with the increase of CKD stages(P <0.05);2)The level of Hcy and the prevalence of HHcys increased non-linearly with the increase of albuminuria stages(P <0.05);3)Whether it is in CKD stages or albuminuria stages,the change of Hcy level is opposite to the trend of the corresponding estimated glomerular filtration rate(eGFR)in each stage;4)Hcy is positively correlated with age,fasting C-peptide(FCP),urine albumin/ creatinine ratio(UACR),blood uric acid(SUA),and duration of diabetes(P <0.05),and negatively correlated with fasting blood glucose(FPG)and glycated hemoglobin HbA1c),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),eGFR,folic acid,and vitamin B12(P <0.05);5)CKD stages is positively correlated with age,systolic blood pressure,FCP,UACR,SUA,Hcy,diabetes course(P <0.05),and negatively correlated with FPG,HbA1 c,TC,LDL,folic acid(P <0.05);6)Albuminuria stages is positively correlated with systolic blood pressure,diastolic blood pressure,FCP,SUA,Hcy,diabetes course(P <0.05),and negatively correlated with HbA1 c,LDL,eGFR,folic acid(P <0.05);7)Multiple logistic regression analysis found that after adjusting for confounding factors,Hcy is an independent risk factor for CKD stage 2,CKD stage 3,CKD stage 4,and CKD stage 5 in T2 DM patients,and the impact of Hcy on the risk of each CKD stage gradually increased with increased CKD stages(P <0.05);8)Multiple logistic regression analysis found that after adjusting confounding factors,Hcy had no effect on the occurrence of albuminuria stages(P> 0.05),but it may indirectly affect the occurrence and progress of albuminuria stages through its impact on eGFR.Conclusion:1.The level of Hcy increased linearly with the increase of CKD stages and increased non-linearly with the increase of albuminuria stages,Hcy level is closely related to the corresponding eGFR level of each stage of type 2 diabetic kidney disease;2.Both CKD stages and albuminuria stages have a positive correlation with Hcy,but the former has a stronger correlation;3.Hcy is an independent risk factor for the progression of CKD stages in type 2diabetic kidney disease patients,and the effects on the occurrence and progression of albuminuria in various stages may be achieved indirectly through its influence on eGFR.4.Hcy may be an indicator of risk stratification of type 2 diabetic kidney disease.