Shih Yu-Lin, Shih Chin-Chuan, Chen Jau-Yuan
Department of Family Medicine, Chang-Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan.
General Administrative Department, United Safety Medical Group, New Taipei City, Taiwan.
Front Med (Lausanne). 2022 Aug 8;9:964101. doi: 10.3389/fmed.2022.964101. eCollection 2022.
Hyperhomocysteinemia is an important factor for endothelial cell damage and a risk factor for cardiovascular diseases. Chronic kidney disease (CKD) is recognized as a leading burden in Taiwan's healthcare system. This study aimed to investigate the association between homocysteine levels and CKD in middle-aged and elderly adults from a community in northern Taiwan.
A total of 396 middle-aged and elderly Taiwanese adults were enrolled and completed the health survey. We divided participants according to tertiles of homocysteine levels as first group (homocysteine level ≤ 11.1 μmol/L), second group (homocysteine level 11.2∼14.3 μmol/L), and third group (homocysteine level > 14.3 μmol/L). CKD was defined as estimated glomerular filtration rate (eGFR) < 60 (mL/min/1.73 m) or urine albumin to creatinine ratio > 30 (mg/g). Pearson correlation was calculated between eGFR and other related risk factors after adjustment for age. The risk of CKD in the second and third groups compared to that in the first group was assessed by multivariate logistic regression after adjustment for age, sex, smoking, hypertension (HTN), diabetes mellitus (DM), body mass index (BMI), dyslipidemia, and uric acid. The Youden index and receiver operating characteristic (ROC) curve were calculated for the optimized cutoff value.
Elevated plasma homocysteine levels were more likely to lower the eGFR and increase the prevalence of CKD. Pearson correlation showed a positive correlation between eGFR and high-density lipoprotein cholesterol, while a negative correlation was observed between homocysteine levels, waist circumference, systolic blood pressure, uric acid levels and BMI (all < 0.05). In the logistic regression analysis, the prevalence of CKD increased, as well as the homocysteine level. The odds ratio of CKD under 95% confidence interval was 2.655 (1.284-5.490) for the third group compared with the first group after adjusting for age, sex, smoking, DM, HTN, dyslipidemia, uric acid, and BMI ( = 0.008). The area under the ROC curve was 0.662, and a cutoff value of 15.15 μmol/L for the homocysteine level was obtained for detecting subjects with CKD.
Our study findings revealed that elevated homocysteine levels were significantly associated with CKD and could be used as an indicator of CKD among the middle-aged and elderly populations in Taiwan.
高同型半胱氨酸血症是导致内皮细胞损伤的重要因素，也是心血管疾病的危险因素。慢性肾脏病（CKD）是台湾医疗体系中的主要负担。本研究旨在调查台湾北部某社区中老年人群中同型半胱氨酸水平与CKD之间的关联。
共纳入396名台湾中老年成年人并完成健康调查。我们根据同型半胱氨酸水平的三分位数将参与者分为第一组（同型半胱氨酸水平≤11.1μmol/L）、第二组（同型半胱氨酸水平11.2∼14.3μmol/L）和第三组（同型半胱氨酸水平>14.3μmol/L）。CKD定义为估算肾小球滤过率（eGFR）<60（mL/min/1.73m²）或尿白蛋白肌酐比值>30（mg/g）。调整年龄后，计算eGFR与其他相关危险因素之间的Pearson相关性。在调整年龄、性别、吸烟、高血压（HTN）、糖尿病（DM）、体重指数（BMI）、血脂异常和尿酸后，通过多因素logistic回归评估第二组和第三组与第一组相比患CKD的风险。计算约登指数和受试者工作特征（ROC）曲线以确定最佳截断值。
血浆同型半胱氨酸水平升高更有可能降低eGFR并增加CKD的患病率。Pearson相关性分析显示，eGFR与高密度脂蛋白胆固醇呈正相关，而同型半胱氨酸水平、腰围、收缩压、尿酸水平和BMI之间呈负相关（均P<0.05）。在logistic回归分析中，CKD的患病率随着同型半胱氨酸水平的升高而增加。调整年龄、性别、吸烟、DM、HTN、血脂异常、尿酸和BMI后，第三组与第一组相比，95%置信区间下CKD的比值比为2.655（1.284 - 5.490）（P = 0.008）。ROC曲线下面积为0.662，同型半胱氨酸水平的截断值为15.15μmol/L，用于检测CKD患者。
我们的研究结果表明，同型半胱氨酸水平升高与CKD显著相关，可作为台湾中老年人群中CKD的一个指标。
