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Elevated homocysteine and differential risks of the renal function decline in hypertensive patients
Chunlei Liu1, Lin Lin2, Rui Xu1,2
1School of Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China.
Insights
Elevated homocysteine (hcy) levels significantly increase the risk of kidney function decline in hypertensive patients. Higher hcy concentrations correlate with a greater decline in estimated glomerular filtration rate (eGFR).
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Homocysteine (hcy) is a known risk factor for predicting renal function decline.
- The specific impact of varying homocysteine levels on renal function has not been fully quantified.
- Hypertension is a prevalent condition associated with kidney disease progression.
Purpose of the Study:
- To investigate the association between different homocysteine concentrations and the rate of renal function decline in hypertensive patients.
- To quantify the risk of declining estimated glomerular filtration rate (eGFR) based on homocysteine levels.
Main Methods:
- Retrospective cohort study of 7,240 hypertensive patients admitted between January 2015 and April 2019.
- Hyperhomocysteinemia defined as serum hcy > 15 μmol/L.
- Logistic and Cox regression models used to analyze the risk of eGFR decline and survival.
Main Results:
- Patients with hyperhomocysteinemia (hcy > 15 μmol/L) showed a significantly higher rate of renal function decline (HR = 1.097, P = .005).
- Adjusted analysis confirmed that hcy > 15 μmol/L increased the hazard of eGFR decrease (aHR = 1.112, P = .002).
- Progressively higher homocysteine levels (10-15, 15-20, >20 μmol/L) were associated with significantly increased risk of renal function decline compared to hcy ≤ 10 μmol/L.
Conclusions:
- Elevated homocysteine concentration is an independent risk factor for renal function decline in hypertensive individuals.
- Homocysteine levels should be considered in the risk stratification for renal function in patients with hypertension.
- Further research may explore therapeutic interventions to lower homocysteine and mitigate kidney function loss.
Importance:
In several studies, homocysteine (hcy) is a documented risk for predicting renal function decline. The differential effects between various levels of hcy have yet to be quantified.
Methods:
In this retrospective cohort study, data was obtained from patients admitted to our hospital from Jan. 2015 to Apr. 2019. Hyperhomocysteinemia is defined as serum hcy concentration >15 μmol/L. Study population eligible subjects included those who had a diagnostic hypertension. The endpoint event was defined as a fall in eGFR between the follow-up and baseline. Logistic regression models were used to examine the related ratio risk results. Cox models were performed to explore the effect of study groups on survival. The significant level was set at a P value of <0.05.
Results:
A total of 7,240 patients presented over 3,564 person-years and were retrospectively enrolled in this study. Overall, 1,145 patients had a hypertension grade 1 [15.8%], 2,455 hypertension grade 2 [33.9%], and 3,640 hypertension grade 3 [50.27%]. Among patients who developed hyperhomocysteinemia (3,604 patients), their renal function had a higher long-term rate of decline (P= .005, hazard ratio (HR) = 1.097, 95% confidence interval (CI) [1.028, 1.171]), compared to patients who didn't developed hyperhomocysteinemia (3,636 patients). After adjusting for covariables, patients' (hcy > 15 μmol/L group) eGFR decreasing had a more hazard ratio (P = .002, aHR= 1.112; 95%CI [1.039, 1.190]). Compared with the serum hcy ≤ 10 μmol/L patients, their renal function decline ratio was higher in the 10 μmol/L < hcy ≤ 15 μmol/L group (P = .008, HR= 1.195, 95% CI [1.048,1.364]), 15 μmol/L < hcy ≤ 20 μmol/L group (P = .000, HR= 1.400, 95%CI [1.227,1.597]), and hcy > 20 μmol/L group (P = .000, HR = 1.475, 95%CI [1.305,1.667]).
Conclusion:
Elevated hcy concentration increases the risk of renal function decline in hypertensive patients. Hcy concentration might also be considered as an important factor in risk stratification of the renal function for hypertensive patients.
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