Serum homocysteine and left ventricular hypertrophy in adults with chronic kidney disease: A case-control study

Hyperhomocysteinemia (serum homocysteine concentration > 15 micromol/L) is of high prevalence in chronic kidney disease (CKD). And myocardial hypertrophy is a common complication of CKD. Given that both hyperhomocysteinemia and cardiac hypertrophy have an association with CKD, we hypothesized that high level of plasma homocysteine (Hcy) is associated with a higher prevalence of ventricular hypertrophy(LVH) in adults with CKD. The registration number of the case-control study is ChiCTR2200064834. The information of inpatients with CKD including Echocardiograms and analysis of plasma Hcy concentrations were collected. We performed linear and logistic regression to investigate the association of plasma Hcy with left ventricular hypertrophy (LVH) (LVMI ≥ 95th percentile), adjusted for levels of hemoglobin, ferritin, cystatin C and β-adrenergic blocker therapy. Further, a stratified analysis of the relationship between plasma Hcy and LVH was carried out according to eGFR. The case records for 1068 inpatients with CKD were collected. After data soring and case-control matching, there were 374 samples screened for statistical analysis. Univariate logistic regression indicated a high level of serum Hcy had an association with LVH (OR, 1.16; 95% CI, 1.11-1.20). Finally, multivariable logistic regression suggested that hyperhomocysteinemia was independently associated with LVH (OR, 1.14; 95% CI, 1.10-1.19) after adjustment for hemoglobin, ferritin, cystatin C, and β-adrenergic receptor blocker therapy. We constructed a predicting model including the variable of Hcy for cardiac hypertrophy in CKD. The model had an area under the ROC curve (AUC) of 0.86 (95% CI: 0.82-0.89, P < .001). The decision curve analysis (DCA) showed a superior net clinical benefit of model with Hcy over model without Hcy. Elevated level of serum Hcy is closely associated with LVH in adults with CKD.