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

Abstract

Hyperhomocysteinemia (HHcy) is considered a risk factor for cardiovascular disease (CVD), including chronic kidney disease (CKD). In this study, we investigated the association between levels of serum homocysteine (Hcy) and mortality, inferred from the presence of CKD. Our study included data of 9895 participants from the 1999 to 2016 National Health and Nutrition Examination Surveys (NHANES). Multivariable-adjusted Cox proportional hazard models using propensity-score, were used to examine doseresponse associations between Hcy level and mortality. A total of 9895 participants, 1025 (10.3%) participants were diagnosed with CKD. In a multivariate Cox regression analysis including all participants, Hcy level was significantly associated with all-cause mortality in the nonCKD group, compared to the 1 st quartile in the fully adjusted model (2 nd quartile: hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.348-2.274, P < .001; 3 rd quartile: HR 2.22, 95% CI 1.726-2.855, P < .001; 4 th quartile: HR 3.77, 95% CI 2.952-4.830, P < .001). However, this finding was not observed in the CKD group. The observed pattern was similar after propensity score matching. In the nonCKD group, overall mortality increased in proportion to Hcy concentration (2 nd quartile:

The Association of Plasma Homocysteine Concentrations with a 10-Year Risk of All-Cause and Cardiovascular Mortality in a Community-Based Chinese Population

“…However, the causal relationships between Hcy and either all-cause or cause-specific mortality was not improved after the supplementation of folic acid or vitamin B in pooled Hcy-lowering clinical trials [ 8 ]. In specific populations, elevated Hcy was associated with the increased risk of all-cause mortality in participants with hypertension [ 9 ], diabetes [ 10 ], and central obesity [ 11 ], respectively, but the relationship between Hcy and all-cause mortality in patients with chronic kidney disease was not found [ 12 ].…”