Serum homocysteine concentration as a marker for advanced diabetic nephropathy in a cohort of elderly patients

Abstract

Background Hyperhomocysteinemia has been linked with chronic kidney disease (CKD). The present study investigated whether homocysteine (Hcy) serum levels might serve as a marker for the advancement of diabetic nephropathy (DN). Methods Clinical and laboratory indicators including Hcy, vitamin D (VD), urine protein, estimated glomerular filtration rate (eGFR) and the urinary protein/creatinine ratio in subjects > 65 years with DN (n = 1,845), prediabetes (n = 1,180) and in a non-diabetes (control) group (n = 28,720) were analyzed. Results DN patients had elevated Hcy concentrations, decreased VD and higher urinary protein levels, a reduced eGFR and a higher urinary protein/creatinine ratio compared with prediabetic and control subjects. After correcting for urinary protein quantitation, multivariate analysis revealed that both the Hcy concentration (P < 0.010) and urinary protein/creatinine ratio (P < 0.001) were risk factors, while the VD2 + VD3 serum concentration (P < 0.001) was a protective factor for DN. Moreover, Hcy > 12 µmol/L was a cut-off value for predicting advanced DN. Conclusion Hcy serum concentration is a potential marker for the advancement of CKD in DN but not prediabetes patients.

Fatores de risco das nefropatias diabéticas na população geriátrica

“…Nos últimos anos, muitos agentes hipoglicemiantes com efeito protetor de órgão tornaram-se disponíveis. Todavia, a avaliação do risco de cada indivíduo continua a ser fundamental para o tratamento adequado da doença renal diabética (TOYAMA et al, 2023;ZHENG;LIU;LIU, 2023;HILL et al, 2023).…”

“…Os fatores de risco associados à nefropatia diabética (ND) incluem dislipidemia, hipertensão, tabagismo, bem como o grau de controle glicêmico. Fatores de risco não modificáveis incluem idade, etnia, perfis genéticos, com hipertensão e hiperglicemia sendo particularmente importantes (ZHENG;LIU;LIU, 2023;HILL et al, 2023).…”

“…A ND é caracterizada por um aumento acentuado na excreção de albumina na urina, lesões glomerulares diabéticas e uma taxa de filtração glomerular estimada reduzida (eGFR) em pacientes com diabetes. No entanto, na população idosa, um declínio da eGFR é um processo fisiológico normal devido ao aumento da glomeruloesclerose e diminuição do número de néfrons funcionais (HILL et al, 2023;ZHENG;LIU;LIU, 2023).…”

The Diagnostic and Prognostic Roles Played by Homocysteine and Other Aminothiols in Patients with Chronic Kidney Disease

“…Hcy can be utilized in two ways-remethylation (RM) or trans-sulfonation (TS)-followed by regeneration into methionine or conversion into cysteine, respectively [18][19][20]. In recent studies, data from experimental and clinical studies have been presented, indicating the association of homocysteine (Hcy) [21][22][23][24][25][26], as well as its precursors SAM and SAH [27][28][29][30][31], with the development of acute and chronic renal failure. At the same time, the mechanisms of methionine cycle disruption in CKD are not fully understood and may be associated with a decrease in the elimination of these metabolites, as well as the violation of their renal and systemic metabolism [32][33][34].…”