Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Medicine (Baltimore). 2022 Sep 9;101(36):e30334. doi: 10.1097/MD.0000000000030334.
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.
高同型半胱氨酸血症(HHcy)被认为是心血管疾病(CVD)的一个危险因素,包括慢性肾脏病(CKD)。在这项研究中,我们研究了血清同型半胱氨酸(Hcy)水平与死亡率之间的关系,这些死亡率可以从 CKD 的存在中推断出来。我们的研究包括了 1999 年至 2016 年全国健康与营养调查(NHANES)的 9895 名参与者的数据。使用倾向评分的多变量调整 Cox 比例风险模型,研究了 Hcy 水平与死亡率之间的剂量-反应关系。在包括所有参与者的多变量 Cox 回归分析中,与完全调整模型中的第 1 四分位相比,Hcy 水平与非 CKD 组的全因死亡率显著相关(第 2 四分位:风险比(HR)1.75,95%置信区间(CI)1.348-2.274,P<0.001;第 3 四分位:HR 2.22,95%CI 1.726-2.855,P<0.001;第 4 四分位:HR 3.77,95%CI 2.952-4.830,P<0.001)。然而,在 CKD 组中没有观察到这种发现。在倾向评分匹配后,观察到的模式是相似的。在非 CKD 组中,总体死亡率随着 Hcy 浓度的升高而升高(第 2 四分位:HR 2.19,95%CI 1.299-3.709,P=0.003;第 3 四分位:HR 2.60,95%CI 1.570-4.332,P<0.001;第 4 四分位:HR 3.72,95%CI 2.254-6.139,P<0.001)。然而,根据 Hcy 水平四分位数,CKD 组的全因死亡率风险并没有增加。本研究仅在非 CKD 组中发现 Hcy 水平与死亡率之间存在相关性。这些改变的危险因素模式可能归因于 CKD 伴随的蛋白质能量消耗或慢性炎症状态。