Hyperhomocysteinemia predicts renal function decline: a prospective study in hypertensive adults

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Biochemistry

Background:

• Hyper-homocysteinemia (HHcy) is linked to kidney damage in general and diabetic populations.
• The association between HHcy and kidney function in hypertensive individuals remains understudied.

Purpose of the Study:

• To determine if HHcy is an independent risk factor for renal function decline.
• To investigate the role of HHcy in the development of chronic kidney disease (CKD) among hypertensive adults.

Main Methods:

• A community-based prospective cohort study involving 2,387 hypertensive adults without CKD at baseline.
• Follow-up averaged 4.4 years, with measurements of plasma homocysteine (Hcy), folate, vitamin B12, blood pressure, and other covariates.
• CKD defined by estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² or eGFR decline rate >1 ml/min/1.73 m²/year.

Main Results:

• A graded association was observed between homocysteine tertiles and eGFR decline.
• Individuals in the highest Hcy tertile showed accelerated eGFR decline and increased risk of incident CKD compared to the lowest tertile.
• These associations persisted after adjusting for multiple confounding factors including age, gender, diabetes, blood pressure, BMI, smoking, dyslipidemia, and vitamin levels.

Conclusions:

• Elevated baseline plasma homocysteine is an independent biomarker for predicting renal function decline in hypertensive adults.
• HHcy is a significant risk factor for the development of incident CKD in this population.
• Findings suggest potential therapeutic targets for preventing kidney disease progression in hypertensive patients.