Impact of Protein Energy Wasting on the Association Between Hyperhomocysteinemia and Death or Dialysis Commencement

Hung-Chieh Wu ； Te-Chun Wang ； Wei-Jie Wang ； Lin-Chien Lee

《Acta Nephrologica》 33卷2期 (2019/06) Pp. 115-125

https://doi.org/10.6221/AN.201906_33(2).0007

摘要

BACKGROUND: It was unsure whether homocysteine (Hcy) was able to predict death or dialysis in advanced chronic kidney disease (CKD) subjects. The aim of the observational cohort study was to examine the associations among Hcy, protein energy wasting (PEW), CKD progression, and death. METHODS: A total of 565 advanced CKD patients were enrolled in Taoyuan General Hospital from June 2016 to June 2019. We reviewed baseline parameters and followed cases about 2 years. Besides baseline Hcy, folic acid, and vitamin B12 levels, Urine urea nitrogen-based protein intake and physical activity-based total energy intake were also estimated for diagnosis of PEW. Hazard ratios for dialysis commencement or composite outcome of dialysis or death by competing risk analysis and the Cox proportional hazard model were calculated. Stratified analysis by PEW also performed. RESULTS: The proportions of PEW and hyperhomocysteinemia (＞ 15 μmol/L) were 19.3% and 84.1%. After conditional backward elimination of predictors for dialysis commencement or death, PEW, hemoglobin, C-reactive protein, creatinine, proteinuria and smoking status were left in the model. In multivariate competing risk analysis for dialysis commencement and proportional hazard analysis for death or dialysis, the highest Hcy tertiles were not independently associated with dialysis (adjusted hazard ratio [aHR] [95% confidence interval] = 1.979 [0.945-4.144]) or composite outcome of death or dialysis in those with PEW (aHR [95% confidence interval] = 1.403 [0.819-2.993], Ps ＞ 0.05). CONCLUSION: Hcy was unpowered to predict death or dialysis in advanced CKD subjects with PEW.

關鍵字

CKD progression ； death ； dialysis ； homocysteine ； protein energy wasting