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Association between homocysteinemia and renal function in patients with type 2 diabetes mellitus
Bilgin Ozmen1, Dilek Ozmen, Nevbahar Turgan
1Department of Endocrinology, Celal Bayar University School of Medicine, Manisa, Turkey.
Insights
Elevated homocysteine levels in type 2 diabetes patients correlate with declining kidney function, indicated by increased cystatin C and albuminuria. This suggests homocysteinemia may link diabetic nephropathy to cardiovascular risks.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Homocysteine is a cardiovascular disease risk factor, but its link with type 2 diabetes and renal dysfunction is unclear.
- Renal function influences plasma homocysteine levels; cystatin C is a marker for glomerular filtration rate (GFR).
Purpose of the Study:
- To investigate the relationships between plasma total homocysteine (tHcy), creatinine clearance (Ccr), serum cystatin C (Cys C), and microalbuminuria in type 2 diabetes patients.
Main Methods:
- Measured plasma tHcy, serum Cys C, serum creatinine, urine microalbumin, and Ccr in 75 type 2 diabetic patients and 40 controls.
- Classified patients into normoalbuminuric (NAU) and microalbuminuric (MAU) groups.
- Analyzed correlations between tHcy, Cys C, creatinine, and microalbuminuria.
Main Results:
- Type 2 diabetics had significantly higher plasma tHcy than controls.
- Microalbuminuric diabetics showed higher serum Cys C levels than normoalbuminurics and controls.
- Positive correlations were found between tHcy and Cys C, and between homocysteine and creatinine in diabetic groups.
Conclusions:
- Elevated plasma tHcy in type 2 diabetics is associated with impaired renal function, evidenced by increased Cys C, Ccr, and microalbuminuria.
- Homocysteinemia may play a role in the link between diabetic nephropathy and cardiovascular complications.
Abstract:
Homocysteinemia is an independent risk factor for cardiovascular disease, but information on its association with type 2 diabetes and mild renal dysfunction is limited. Plasma total homocysteine (tHcy) concentration is partly determined by renal plasma clearance. Serum cystatin C (Cys C) concentration has been introduced as a marker of renal function, specifically as an indicator of glomerular filtration rate (GFR). The aim of this study was to explore the relationships among tHcy, creatinine clearance (Ccr), serum Cys C, and microalbuminuria in a population with type 2 diabetes. Fasting plasma tHcy, serum homocysteine-related vitamins (folate and vitamin B12), serum Cys C, serum creatinine, urine microalbumin, and creatinine clearance were determined in 75 type 2 diabetic patients and 40 healthy control subjects. The patients were assigned to two groups based on urinary albumin excretion (UAE): normoalbuminuric (NAU, UAE < 30 mg/24 hr, n = 35) and microalbuminuric (MAU, UAE 30-300 mg/24 hr, n = 40). Ccr was calculated using the Cockroft-Gault formula. Plasma Hcy levels were determined by HPLC with fluorescence detection and serum Cys C by automated particle enhanced immunoturbidimetry. Plasma tHcy levels were significantly higher in normoalbuminuric and microalbuminuric patients than in controls (10.64 +/- 0.53, 13.29 +/- 0.78, 6.91 +/- 0.37 mmol/L, respectively). Serum Cys C levels in microalbuminuric diabetics were higher than in normoalbuminurics and controls (1.36 +/- 0.06, 1.12 +/- 0.04, 1.10 +/- 0.06 mg/ L, respectively). Positive correlations were noted between tHcy and Cys C levels in normoalbuminuric and microalbuminuric diabetics (r = 0.72, r = 0.64, respectively). Homocysteine and creatinine concentrations were correlated in both diabetic groups (r = 0.89, r = 0.93, NAU and MAU, respectively). Elevated plasma total homocysteine concentrations in type 2 diabetics suggest an association between homocysteinemia and deterioration of renal function, evidenced by increased serum creatinine and Cys C, Ccr, and microalbuminuria. These findings implicate homocysteinemia in the relationship between diabetic nephropathy and cardiovascular complications of diabetes.