Analysis Of The Incidence And Related Factors Of Hyperhomocysteinemia In Patients With Non-dialysis Chronic Kidney Disease

Objective:To study the incidence of HHcy in Department of Renal Medicine of the Second Hospital of Shanxi Medical University,and analyze its related factors in ND-CKD patients,so as to provide theoretical basis for clinical prevention and treatment of HHcy,and to reduce cardiovascular and cerebrovascular adverse events caused by HHcy.Methods:Firstly,all basic data of 480 ND-CKD patients hospitalized in the Department of Renal Medicine of the Second Hospital of Shanxi Medical University from January 2016to November 2019 were collected.Finally,460 patients were included in the study according to the exclusion criteria and screening criteria.According to the diagnostic criteria of Hcy,the patients were divided into the HHcy group and the the normal Hcy group.Based on glomerular filtration rate GFR,the patients were divided into GFR≥60 ml·min^-1·（1.73 m²）^-1,namely CKD1-2 stage;GFR<60 ml·min^-1·（1.73 m²）^-1,namely stage CKD3-5.Univariate analysis was used to compare the clinical data of the two groups,Logistic regression analysis was used to study the influencing factors of HHcy in ND-CKD patients,and then the ROC curve was used to study the predictors of HHcy in ND-CKD patients.Results:Among the 460 ND-CKD patients included,the prevalence of HHcy was 53.00%,and the incidence of HHcy in CKD stage 1 to 5 was 7.40%,13.50%,24.60%,25.00%,29.50%,respectively.Multiariate Logistic regression analysis showed that the related factors included CKD stage（OR=0.669）,diastolic blood pressure（OR=0.942）,triglyceride（OR=0.416）,uric acid（OR=0.996）and 24h urine protein quantification（OR=1.669）;uric acid（OR=4.549）and triglyceride（OR=0.543）were the related factors for the occurrence of HHcy in patients with ND-CKD at stage 1-2.CKD stage（OR=0.250）,diastolic blood pressure（OR=0.920）,creatinine（OR=1.050）,urea nitrogen（OR=0.539）,uric acid（OR=1.004）,triglyceride（OR=0.769）and 24h urine protein quantification（OR=0.515）were the relevant factors for the occurrence of HHcy in ND-CKD patients at stage 3-5.The results of ROC curve analysis showed that CKD staging was a good indicator for the prediction of HHcy in patients with ND-CKD,especially for stage 3-5 ND-CKD patients.Conclusion:（1）With the aggravation of the renal function impairment in CKD patients,the incidence of HHcy is gradually increased and more and more factors affecting blood Hcy level are also involved.（2）The related factors included CKD stage,diastolic blood pressure,triglyceride,uric acid and 24h urine protein quantification.（3）Uric acid and triglyceride were the related factors for the occurrence of HHcy in patients with ND-CKD at stage 1-2.（4）CKD stage,diastolic blood pressure,creatinine,urea nitrogen,uric acid,triglyceride and 24h urine protein quantification were the relevant factors for the occurrence of HHcy in ND-CKD patients at stage 3-5.