The relationship between plasma homocysteine and renal dysfunction in elderly patients with coronary heart disease / 中华老年医学杂志

ABSTRACT

Objective:To explore the relationship between plasma homocysteine level and renal dysfunction in elderly patients with coronary heart disease(CHD).Methods:Eight hundreds and fifty-eight elderly patients with CHD were enrolled at cardiology department of our hospital from January 2015 to July 2017.The patients were divided into the renal insufficiency(RI, defined as an estimated glomerular filtration rate(eGFR)<60 ml/min)group and the non-kidney disease(NKD)group.Using the random number table, the RI group was randomly sub-grouped into the intervention group and the placebo group.The intervention group was treated with folic acid(10 mg/d), vitamin B6(10 mg/d)and vitamin B12(1 mg/d), while the placebo group was given oral placebo.Serum homocysteine(Hcy), creatinine(Cr), blood urea nitrogen(BUN), total cholesterol(TC), triglyceride(TG)and hemoglobin(Hb)were measured by enzyme-linked immunosorbent assay.Pearson correlation was used to analyze the correlations of Hcy with Cr, BUN and eGFR between the RI and NKD groups.Plasma Hcy, Cr, BUN and Hb levels before, and 6, 12 months after treatment were determined and compared between the two subgroups.Staging of renal function was analyzed and clinical effect was evaluated 12 months after treatment in the two subgroups.Results:Serum levels of Hcy, Cr and BUN were higher( t=3.174, 4.857 and 2.644, all P=0.000)and the level of eGFR was lower( t=-2.867, P=0.000)in the RI group than in the NKD group.Plasma Hcy level was positively correlated with plasma levels of Cr and BUN( r=0.308 and 1.214, all P=0.000)and negatively correlated with the eGFR level( r=-0.148, P=0.003). There was no significant difference in plasma Hcy, Hb, Cr and BUN levels between the intervention and placebo group before treatment( P>0.05). At each monitoring time point, serum levels of Hcy, Cr and BUN were decreased continuously in the intervention group( F=314.527, 234.861 and 176.332, P=0.012, 0.000 and 0.006), while plasma Hcy level had no significant change and plasma levels of Cr and BUN were increased continuously in the placebo group( F=196.427, 223.753 and 314.552, P=0.216, 0.000 and 0.002). After 12 months of treatment, plasma levels of Hcy, Cr and BUN were lower in the intervention group than in the placebo group( t=1.284, 0.779 and 2.541, P=0.016, 0.000 and 0.005). There was no significant difference in plasma Hb level between the two subgroups before and after treatment( F=113.764, P=0.182). There was no significant difference in the renal function staging between the two subgroups before treatment( χ2=4.263, P=0.119), while it was improved in the intervention group versus in the placebo group at the end of follow-up( χ2=73.599, P=0.000). Conclusions:The high level of plasma Hcy can be regarded as an independent risk factor for renal insufficiency, and has a correlation with the renal disease progression and prognosis in elderly patients with CHD.