Related Experiment Video
Updated: Aug 29, 2025
A Mouse 5/6th Nephrectomy Model That Induces Experimental Uremic Cardiomyopathy
Published on: November 7, 2017
Association between homocysteinemia and mortality in CKD: A propensity-score matched analysis using NHANES-National
Je Hun Song1, Hyuk Huh2, Eunjin Bae3
1Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Insights
High homocysteine (Hcy) levels are linked to increased mortality risk in individuals without chronic kidney disease (CKD). However, this association was not found in patients with CKD, suggesting different risk factor patterns in this group.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Epidemiology
Background:
- Hyperhomocysteinemia (HHcy) is a known risk factor for cardiovascular disease (CVD), including chronic kidney disease (CKD).
- The relationship between serum homocysteine (Hcy) levels and mortality, particularly in the context of CKD, requires further investigation.
Purpose of the Study:
- To investigate the association between serum homocysteine (Hcy) levels and all-cause mortality.
- To determine if the presence of chronic kidney disease (CKD) modifies the association between Hcy levels and mortality risk.
Main Methods:
- Utilized data from 9895 participants in the National Health and Nutrition Examination Surveys (NHANES) from 1999-2016.
- Employed multivariable-adjusted Cox proportional hazard models and propensity-score matching to analyze dose-response associations between Hcy levels and mortality.
- Stratified analyses were conducted for participants with and without CKD.
Main Results:
- In the non-CKD group, elevated Hcy levels were significantly associated with increased all-cause mortality in a dose-dependent manner.
- This significant association between Hcy levels and mortality was not observed in the CKD group.
- Propensity score matching confirmed these findings, indicating Hcy levels are a mortality risk factor only in individuals without CKD.
Conclusions:
- Serum homocysteine levels are correlated with mortality risk exclusively in individuals without chronic kidney disease.
- Altered risk factor patterns in CKD patients, potentially due to protein-energy wasting or chronic inflammation, may explain the lack of association between Hcy and mortality.
- Further research is needed to elucidate the mechanisms underlying these differential associations.
Abstract:
Hyperhomocysteinemia (HHcy) is considered a risk factor for cardiovascular disease (CVD), including chronic kidney disease (CKD). In this study, we investigated the association between levels of serum homocysteine (Hcy) and mortality, inferred from the presence of CKD. Our study included data of 9895 participants from the 1999 to 2016 National Health and Nutrition Examination Surveys (NHANES). Multivariable-adjusted Cox proportional hazard models using propensity-score, were used to examine dose-response associations between Hcy level and mortality. A total of 9895 participants, 1025 (10.3%) participants were diagnosed with CKD. In a multivariate Cox regression analysis including all participants, Hcy level was significantly associated with all-cause mortality in the nonCKD group, compared to the 1st quartile in the fully adjusted model (2nd quartile: hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.348-2.274, P < .001; 3rd quartile: HR 2.22, 95% CI 1.726-2.855, P < .001; 4th quartile: HR 3.77, 95% CI 2.952-4.830, P < .001). However, this finding was not observed in the CKD group. The observed pattern was similar after propensity score matching. In the nonCKD group, overall mortality increased in proportion to Hcy concentration (2nd quartile: HR 2.19, 95% CI 1.299-3.709, P = .003; 3rd quartile: HR 2.60, 95% CI 1.570-4.332, P < .001; 4th quartile: HR 3.72, 95% CI 2.254-6.139, P < .001). However, the risk of all-cause mortality according to the quartile of Hcy level, did not increase in the CKD group. This study found a correlation between the Hcy level and mortality rate only in the nonCKD group. These altered risk factor patterns may be attributed to protein-energy wasting or chronic inflammation status, that is accompanied by CKD.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:24Chronic Kidney Disease II: Clinical Manifestations
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:18Chronic Kidney Disease IV: Nursing Management