Correlation of Homocysteine with Cardiovascular and All-Cause Mortality in Patients on Maintenance Hemodialy-sis
Objective To explore the influencing factors of hyperhomocysteinemia(HHcy)in the patients on maintenance hemodialysis(MHD),and to clarify the relationship between homocysteine(Hcy)levels and the risk of death in MHD pa-tients.Methods A total of 284 patients with end-stage renal disease(ESRD)and on MHD in the Dongfeng General Hospi-tal from June 1,2021 to May 31,2023 who met the inclusion criteria were enrolled in this study.The general information and the chemical indicator levels of the patients were collected.The patients were assigned into a death group and a survival group according to the death or survival conditions and a normal Hcy group and an elevated Hcy group according to the Hcy level.Kaplan-Meier and Log-rank tests were carried out to compare the survival rates between the two Hcy groups.Spearman correlation analysis was employed to analyse the factors affecting Hcy levels.Cox regression was performed to screen risk factors for the death in MHD patients.Finally,the receiver operating characteristic(ROC)curve was estab-lished to analyse the predictive value of Hcy for all-cause mortality in MHD patients.Results The Kaplan-Meier survival curves showed that the elevated Hcy group had higher mortality(Log-rank test χ2=6.288,P=0.012)and shorter median survival time than the normal Hcy group,suggesting that the level of Hcy can predict all-cause death in MHD patients.Af-ter correction of multiple confounders by multivariate Cox regression,the Hcy level was still significantly associated with the mortality of MHD patients,which indicated that elevated Hcy was an independent risk factor for death in MHD patients.The area under the ROC curve for the prediction of the death of MHD patients by Hcy was 0.783,which was greater than 0.7,suggesting that Hcy had a predictive value of the all-cause death of MHD patients.Conclusion Serum Hcy is associated with cardiovascular and all-cause mortality in MHD patients,serving as a strong predictor of patient death.Hcy is expected to be a new indicator for assessing the risk of death in MHD patients.
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