Analysis And Correlation Between Homocysteine Level And Risk Factors Of Abdominal Aortic Calcification In Patients With Chronic Kidney Disease

Background : chronic kidney disease(CKD)has become one of the major diseases endangering human life and health.Cardiovascular disease is the main cause of death in CKD,especially after entering the End stage renal disease(ESRD),the incidence of cardiovascular complications will increase by 15 to 20 times.homocysteine(Hcy)is a biochemical indicator that has attracted much attention,and it is one of the five said high in recent years(the other four are high blood pressure,high blood sugar,high blood fat and high uric acid).Hcy is considered to be an independent risk factor for cardiovascular disease,and Hyperhomocysteinemia(HHcy)is called hyperhomocysteinemia(HHCY)when Hcy levels rise beyond normal values.Vascular calcification is a common phenomenon in the progression of CKD,in which Abdominal aorta calcification(AAC)is more common.Existing studies have shown a certain correlation between Hcy level and vascular calcification.However,there are few studies on the relationship between Hcy level and vascular calcification in patients with CKD,which are mostly carried out in dialysis patients,and fewer studies on patients who have not received kidney replacement therapy.Therefore,it is of great significance to pay attention to the influencing factors of Hcy level and vascular calcification in early CKD patients as well as the correlation between them,and make timely clinical intervention for HHcy and vascular calcification,which is of great significance to reduce the risk of death from cardiovascular diseases in CKD patients.Objective:To investigate the prevalence and influencing factors of AAC and HHcy in patients with stage CKD3-5 who did not receive renal replacement therapy,and to analyze the predictive value of the influencing factors for the clinical diagnosis of AAC and HHcy.To explore the correlation between AAC and HHcy.Methods:Basic data,biochemical indexes and lateral abdominal radiographs were collected.Patients were divided into group A(normal Hcy group,Hcy <15umol/L)and group B(elevated Hcy group,Hcy≥15umol/L).As aortic calcification score(AACS)was obtained by Kauppila calcification score,patients were divided into C group(normal aortic group,AACS = 0)and D group(abdominal aortic calcification group,AACS > 0).The general conditions and biochemical indicators of group A,group B,group C and group D were respectively compared,and the independent risk factors of HHcy and AAC were identified by binary logistic regression analysis.ROC curve was drawn to analyze the diagnostic and predictive value of each influencing factor on HHcy and AAC.Spearman correlation analysis was used to analyze the correlation between Hcy and AAC scores.Results:1.A total of 102 eligible patients were collected,the prevalence of HHcy was 69.61%,the prevalence of AAC was 49.02%,61(59.80%)males,41(40.20%)females,age(27-82(62.83±13.49))years old.e GFR(5.84-59.63(25.32±16.32))[ml/min·1.73m2],BMI(23.62±3.82)(kg/m2),39 patients with stage CKD3,22 patients with stage 4,41 patients with stage 5,43 patients with glomerulonephritis(42.15%),There were 22 patients with diabetic nephropathy(21.57%),15 patients with hypertensive nephropathy(14.71%),13 patients with obstructive nephropathy(12.75%),3 patients with hyperuric acid nephropathy(2.94%),2 patients with nephrotic syndrome(1.96%),2 patients with Ig A nephropathy(1.96%),and 1 patient with polycystic kidney disease(0.98%).Lupus nephritis was found in 1 patient(0.98%).2.The comparison between group A and group B showed that the smoking history ratio,hypertension history ratio,age,blood uric acid,i PTH,AACS and Scr levels in group B were higher than those in group A,and the differences were statistically significant,P< 0.05;Folate level in group B was lower than that in group A,and the difference was statistically significant,P<.0.05;Binary logistic regression6 suggested that folic acid deficiency(OR=0.524,P=0.001)was an independent risk factor for HHcy in CKD patients.With HHcy as the state variable and folic acid as the test variable,ROC curve was drawn.The optimal prediction effect was obtained when folic acid level was 14.105ng/ml as the cut-off value,and the area under ROC curve(AUC)was 0.976(95%CI :0.952-1.000,P< 0.001),the sensitivity and specificity were 96.80% and 91.50%,respectively,suggesting that folic acid deficiency was a good diagnostic predictor of HHcy in patients with CKD.3.The comparison between group C and D showed that the smoking history,hypertension history,diabetes history,age,blood uric acid,i PTH,blood phosphorus,LDL,Hcy and TG of group D were higher than those of group C,and the differences were statistically significant,P<0.05;The level of 25-hydroxyvitamin D in group D was lower than that in group C,and the difference was statistically significant,P<0.05;Binary logistic regression suggested a history of hypertension(OR=21.011,P=0.005),elevated blood uric acid(OR=1.018,P=0.002),elevated blood phosphorus(OR=5.665,P=0.030),elevated LDL(OR=3.435,P=0.034),and25-hydroxyvitamin D deficiency(OR=0.863,P=0.025)was an independent risk factor for AAC.The combined prediction of hypertension history,blood uric acid,blood phosphorus,LDL,25-hydroxyvitamin D and the above indexes were used as test variables,and the AUC of hypertension history was 0.679(95%CI: 0.5744-0.784,P=0.002)by ROC curve analysis with AAC as state variable.Serum uric acid AUC was 0.827(95%CI:0.745-0.909,P < 0.001),serum phosphorus AUC was 0.743(95%CI:0.646-0.839,P<0.001),the LDL level AUC was 0.735(95%CI:0.632-0.838,P<0.001),25-hydroxyvitamin D levels were 0.727(95%CI:0.629-0.826,P<0.001),combined forecast AUC of 0.946(95%CI:0.906-0.986,P < 0.001),suggesting that combined hypertension history,blood uric acid,blood phosphorus,LDL,25-hydroxyvitamin D and other indicators have good predictive value for the occurrence of AAC in patients.4.Spearman correlation analysis showed that there was a positive correlation between Hcy and AACS.The higher the level of Hcy,the higher the degree of AACS,and the more severe the degree of calcification [rank correlation coefficient(rs=0.582),P<0.001].Conclusions:1.In this study,the prevalence rate of HHcy was 69.61%.Folic acid deficiency is an independent risk factor for HHcy in patients with stage CKD3-5who did not receive renal replacement therapy.Folic acid deficiency has a good diagnostic and predictive value for HHcy in patients.2.In this study,the prevalence of AAC was 49.02%.History of hypertension,elevated uric acid,elevated blood phosphorus,elevated LDL,and 25-hydroxyvitamin D deficiency were independent risk factors for AAC in patients with stage CKD3-5who did not receive renal replacement therapy.The combination of all the above indicators could better predict the occurrence of AAC in patients than single indicators.3.There was a positive correlation between the level of Hcy and AAC in patients with stage CKD3-5 who did not receive renal replacement therapy,and the correlation was moderate.The higher the level of Hcy,the higher the level of AACS,and the heavier the degree of calcification.