Correlation of serum homocysteine with HbA1c and kidney function in type 2 diabetic patients: insights from estimated glomerular filtration rate and renal impairment

Vineet Kumar; Yuvraj Gulati; Richa Giri; Verma Rajendra Kumar Babulal; Punit Varma; Chayanika Kala

doi:10.18203/2320-6012.ijrms20244121

Authors

Vineet Kumar Department of Medicine, GSVMMC, Kanpur, Uttar Pradesh, India
Yuvraj Gulati Department of Nephrology, GSVMMC, Kanpur, Uttar Pradesh, India
Richa Giri Department of Medicine, GSVMMC, Kanpur, Uttar Pradesh, India
Verma Rajendra Kumar Babulal Department of Medicine, GSVMMC, Kanpur, Uttar Pradesh, India
Punit Varma Department of Community Medicine, GSVMMC, Kanpur, Uttar Pradesh, India
Chayanika Kala Department of Pathology, GSVMMC, Kanpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20244121

Keywords:

HbA1c, eGFR, Type 2 diabetes mellitus, Biomarkers, Diabetic nephropathy, Serum homocysteine

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder associated with complications, particularly diabetic nephropathy (DN), a major cause of end-stage renal disease (ESRD). Early detection of DN is essential to prevent progression. Serum homocysteine (Hcy), a marker linked to oxidative stress and endothelial dysfunction, has shown potential in predicting vascular and renal complications. However, its relationship with glycemic control (HbA1c) and kidney function (eGFR) remains underexplored. This study examines these correlations in T2DM patients.

Methods: This cross-sectional study included 156 T2DM patients recruited from G.S.V.M. medical college, Kanpur (January 2023-April 2024). Serum Hcy, HbA1c, and eGFR were measured using standardized techniques. Pearson and Spearman correlations, along with multiple linear regression, were used to evaluate relationships while adjusting for confounders like age, diabetes duration, and lipid profile.

Results: Serum Hcy levels demonstrated a significant positive correlation with HbA1c (r=0.47, p<0.01), indicating an association with poorer glycemic control. Additionally, a negative correlation was observed between serum Hcy and eGFR (r=-0.52, p<0.001), suggesting that elevated homocysteine levels were associated with declining kidney function. These correlations remained significant after adjustments for confounders.

Conclusions: Elevated serum homocysteine is strongly associated with higher HbA1c and lower eGFR, suggesting its potential as a biomarker for glycemic control and renal impairment in T2DM. Routine homocysteine measurement could aid early DN detection and management. Further studies are needed to validate these findings.

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References

Cerf ME. Beta Cell Dysfunction and Insulin Resistance. Front Endocrinol. 2013;4:37.

Varghese RT, Jialal I. Diabetic Nephropathy. In: StatPearls. StatPearls Publishing. 2024.

Lee J, Yun JS, Ko SH. Advanced Glycation End Products and Their Effect on Vascular Complications in Type 2 Diabetes Mellitus. Nutrients. 2022;14(15):3086.

Estimated Glomerular Filtration Rate (eGFR) | National Kidney Foundation. Available at: https://www.kidney.org/kidney-topics/estimated-glomerular-filtration-rate-egfr. Accessed on 10 November 2024.

Townsend DM, Tew KD, Tapiero H. Sulfur containing amino acids and human disease. Biomed Pharmacother. 2004;58(1):47.

Ganguly P, Alam SF. Role of homocysteine in the development of cardiovascular disease. Nutr J. 2015;14:6.

Stühlinger MC, Tsao PS, Her JH, Kimoto M, Balint RF, Cooke JP. Homocysteine impairs the nitric oxide synthase pathway: role of asymmetric dimethylarginine. Circulation. 2001;104(21):2569-75.

Ozmen B, Ozmen D, Turgan N, Habif S, Mutaf I, Bayindir O. Association between homocysteinemia and renal function in patients with type 2 diabetes mellitus. Ann Clin Lab Sci. 2002;32(3):279-86.

Looker HC, Fagot-Campagna A, Gunter EW, Pfeiffer CM, Venkat NKM, Knowler WC, et al. Homocysteine as a risk factor for nephropathy and retinopathy in Type 2 diabetes. Diabetologia. 2003;46(6):766-72.

Francis ME, Eggers PW, Hostetter TH, Briggs JP. Association between serum homocysteine and markers of impaired kidney function in adults in the United States. Kidney Int. 2004;66(1):303-12.

Xu W, Tang S, Xiang M, Peng J. Serum Homocysteine, cystatin C as Biomarkers for Progression of Diabetic Nephropathy. Pteridines. 2019;30(1):183-8.

House AA, Eliasziw M, Cattran DC. Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial. JAMA. 2010;303(16):1603-9.

Ma L, Liu Q, Jiang Y, Hailing Z, Tingting Z, Yongtong C, et al. Genetically elevated circulating homocysteine concentrations increase the risk of diabetic kidney disease in Chinese diabetic patients. J Cell Mol Med. 2019;23(4):2794-800.