Correlation And Prediction Of Homocysteine On Renal Function Decline In Type 2 Diabetes Mellitus

Objective:To investigate the relationship between serum homocysteine(Hcy)concentration and renal function in patients with type 2 diabetes mellitus,and to predict the risk of renal function changes by homocysteine.Methods:A total of 427 patients with type 2diabetes mellitus admitted to the endocrinology department,the First Affiliated Hospital of Shenzhen University were enrolled.According to the quartile method,homocysteine were divided into four subgroups,H1 group(<10.3?mol/L),H2 group(10.3~12.6?mol/L),H3group(12.6~15.4?mol/L)and H4 group(>15.4?mol/L).According to the renal function level,eGFR(estimated glomerular filtration rate)were divided into two groups,eGFR?60ml/(min·1.73m~2)and eGFR<60ml/(min·1.73m~2).Compare the differences of the general data and biochemical indicators,homocysteine,eGFR levels and so on.Analysis of the correlation among homocysteine levels,eGFR and sex,age,age of onset,duration of diabetes,BMI,waist-hip ratio,blood pressure and biochemical indicators.Univariate logistic analysis was used to find factors related to eGFR decline,and binary logistic regression was used to analyze risk factors for eGFR<60ml/(min·1.73m~2).Using stratified interaction test to analysis the factors that may affect the relationship between homocysteine and eGFR.Multiple linear regression equation analysis was used to analyze the related risk factors of renal function decline in patients with type 2 diabetes mellitus.The ROC curve was used to observe the effect of Hcy on eGFR,find the corresponding cut-off value,and better predict the progression of renal function through the joint model.Quantify forecasting indicators through decision trees and nomograms to facilitate better risk assessment.Result:Compared with the four subgroups of Hcy,the higher level group with more male patients,the age and onsetting age were larger(P<0.05).The duration of diabetes was longer(P=0.005)and the systolic blood pressure was higher(P=0.024),BMI,waist hip ratio,F-CP,2hP-CP,SUA,and 24h urinary albumin levels were increased(P<0.05),smoking history,drinking history,hypertension history were higher(P<0.05),The eGFR and HbA1c levels were relatively low(P<0.05).There was also a statistically significant difference in the proportion of CKD patients between the four subgroups(P<0.001).Correlation analysis suggested that Hcy and age,duration of diabetes,BMI,waist-to-hip ratio,systolic blood pressure,F-CP,2hP-CP,TG,SUA,24-hour urinary albumin,smoking history,drinking history,history of hypertension,lower extremity arteries plaque and CKD stages were positively correlated(P<0.05),but negatively correlated with eGFR,gender,and HbA1c(P>0.05).The effect of stratified interaction tests on gender,serum uric acid,24-hour urinary albumin,and hypertension history did not affect the relationship between Hcy and eGFR.Multiple linear regression equation analysis showed that homocysteine was an independent risk factor for predicting renal insufficiency in diabetic patients.The ROC curve shows that when Hcy is above13.15?mol/L,the incidence of renal function decline in patients with T2DM will increase significantly.The area under the ROC curve of combined hemocysteine,24-hour urinary albumin,and serum uric acid to predict renal function decline in patients with type 2 diabetes was 0.895.Decision trees and nomograms can be used to assess the risk of renal insufficiency based on the specific quantitative values of hemocysteine,24-hour urinary albumin,and serum uric acid.Conclusion:The homocysteine level is closely related to renal function in patients with type 2 diabetes.It is an independent risk factor for predicting the progression of renal function in diabetic patients.Combined Hcy,24-hour urine albumin,and serum uric acid can better predict the risk of renal insufficiency.