Hyperhomocysteinemia Concurrent with Metabolic Syndrome Is Independently Associated with Chronic Kidney Disease among Community-Dwelling Adults in an Urban Korean Population

Abstract

Elevated homocysteine (Hcy) levels and metabolic syndrome (MetS) are associated with chronic kidney disease (CKD). We investigated the combined effects of hyperhomocysteinemia (HHcy) and MetS on CKD among community-dwelling adults in an urban area of South Korea. We also identified the combination of HHcy and individual MetS components associated with the maximal risk of CKD. A retrospective cross-sectional study involving 19,311 health examinees between 2 January 2011 and 31 December 2015 was conducted. The participants were divided into four groups—namely, the HHcy−/MetS−, HHcy−/MetS+, HHcy+/MetS−, and HHcy+/MetS+ groups. CKD was defined as a low eGFR <60 mL/min/1.73 m2 or albuminuria. The HHcy+/MetS+ group had a higher risk of CKD than the HHcy−/MetS+ group (odds ratio (OR): 1.750, p = 0.002 for males; OR: 3.224, p < 0.001 for females). The HHcy+/MetS+ group had a higher CKD risk than the HHcy+/MetS− group; however, the difference was not statistically significant (OR: 1.070, p = 0.712 for males; OR: 1.847, and p < 0.074 for females). HHcy concurrent with MetS increased the CKD risk. Among the combinations of HHcy and MetS components, the coexistence of HHcy and central obesity had the greatest effect on CKD. Therefore, the timely detection and treatment of HHcy and MetS are important for preventing CKD.

The Association between Homocysteinemia and Mortality in Pre-dialysis CKD patients: A Propensity-Score Matched Analysis Using NHANES-National Death Index Link

“…Although BMI, serum cholesterol, and high blood pressure are traditional risk factors for cardiovascular disease and mortality in the general population, in patients with CKD with regards to Hcy, the results of prior studies reveals the effect of reverse epidemiology in these traditional risk factors [18,31]. Although HCY is known to be increased in CKD patients [32,33], ndings regarding whether it is an independent risk factor for increasing CVD risk in CKD patients are inconclusive [34][35][36][37]. In two studies with 367 and 88 hemodialysis patients, respectively, the low Hcy level in ESRD patients was observed to increase CVD outcome [38,39]; moreover, Hcy also showed a reverse epidemiology pattern as mentioned above.…”

Metabolic Syndrome-Related Kidney Injury: A Review and Update

“…Growth differentiation factor 15 (GDF-15) is an endocrine factor involved in metabolism, and GDF-15 levels have been found to be significantly increased in elderly MetS patients and has been independently correlated with MetS (103,104). A study from the Japanese found that urinary A-megalin is associated with the clustering number of MetS traits including hyperhomocysteinemia (105,106). At present, Urinary podocyte-derived EVs (pEVs) is widely recognized as a specific biomarker for podocyte injury, and studies have found that it is significantly increased in secondary podocytes, such as early diabetic nephropathy, hypertensive nephropathy, and eclampsia (107)(108)(109).…”

Association between homocysteinemia and mortality in CKD: A propensity-score matched analysis using NHANES-National Death Index

“…Although BMI, serum cholesterol, and high blood pressure are traditional risk factors for cardiovascular disease and mortality in the general population, in patients with CKD with regards to Hcy, the results of prior studies reveals the effect of reverse epidemiology in these traditional risk factors. [32] Although Hcy is known to be increased in CKD patients, [33,34] findings regarding whether it is an independent risk factor for increasing CVD risk in CKD patients are inconclusive. [35][36][37][38] In 2 studies with 367 and 88 hemodialysis patients, respectively, the low Hcy level in ESRD patients was observed to increase CVD outcome; moreover, Hcy also showed a reverse epidemiology pattern as mentioned above.…”