Correlation among cystatin C, homocysteine and arteriosclerosis indexes in patients with chronic kidney disease.

OBJECTIVES

Chronic kidney disease (CKD) has become an important public health problem in the world. The occurrence of cardiovascular events is the main cause of death in patients with CKD, and arteriosclerosis is an important pathophysiological basis for cardiovascular diseases. Nowadays, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) are clinically important indicators to reflect early atherosclerosis. Cystatin C (Cys C)and homocysteine (Hcy) are related to arteriosclerosis in healthy, hypertensive, and diabetic people, while there are few studies on the correlation among Hcy, CysC and arteriosclerosis in patients with CKD. This study aims to investigate the relationship between Cys C, Hcy and atherosclerosis in patients with CKD.

METHODS

A total of 611 individuals, who met the diagnostic criteria for CKD and underwent physical examination in the Health Management Center of Third Xiangya Hospital, Central South University from June 2019 to June 2020, were selected as the research subjects. Height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured and recorded, and body mass index (BMI) was calculated. Blood samples (5 mL) were collected and Cys C, Hcy, fasting blood glucose (FBG), total cholesterol (TC), serum creatinine (SCr), and other blood indexes were tested. Urine was collected to detect microalbumin and creatinine, and the albumin/creatinine ratio (UACR) was calculated. baPWV and ABI were measured by automatic arteriosclerosis detector. The quartiles of Cys C and Hcy were divided into groups, and the proportion of baPWV and ABI abnormalities among groups was compared pairwise. The correlation between Cys C, Hcy, and baPWV was analyzed by Pearson correlation analysis. Univariate and multivariate logistic regression were used to analyze the effects of Cys C and Hcy on ABI and baPWV.

RESULTS

Among 611 patients with CKD, 435 (71.19%) had abnormal baPWV and 48 (7.86%) had abnormal ABI. With the increase of Cys C and Hcy levels, the proportion of baPWV and ABI abnormalities were gradually increased. BaPWV was positively correlated with Cys C (=0.32) and Hcy (=0.20). After adjusting for confounding factors such as gender, BMI, and FBG, Cys C (OR=6.54, 95% CI 1.93 to 22.14, <0.01) and Hcy (OR=1.08, 95% CI 1.01 to 1.16, =0.02) were independent risk factors for abnormal baPWV. Also, after adjusting for confounding factors such as age, sex, BMI, and FBG, Cys C (OR=9.95, 95% CI 2.84 to 34.92, <0.01) and Hcy (OR=1.06, 95% CI 1.01 to 1.11, =0.02) were independent risk factors for abnormal ABI.

CONCLUSIONS

In patients with CKD, baPWV and ABI are significantly correlated with Cys C and Hcy levels. Detection of Cys C and Hcy levels is helpful for the early diagnosis of arteriosclerosis.