Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis  patients   HUANG Jia1, LEI Juan-juan1, LI Han1, WANG Shi-xiang1    1Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China

Corresponding author: LI Han, Email: hanli@ccmu.edu.cn

【Abstract】Objective  To investigate the associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis patients (MHD). Methods  176 MHD patients in Beijing Chao-Yang Hospital Affiliated to Capital Medical University from January 2014 to December 2021 were analyzed retrospectively. Patients whose plasma homocysteine (Hcy) ≤30μmol/L were divided into the normal-mild group, and whose plasma Hcy＞30μmol/L were divided into moderate-severe groups. The indexes of left ventricular by cardiac ultrasound were compared between the 2 groups, and the correlation between plasma Hcy and left ventricular indexes was analyzed. We also explored whether there was an interaction between plasma Hcy and other risk factors of cardiovascular disease on left ventricular structural and functional.  Results  74 patients were enrolled in the normal-mild group, and 102 patients were enrolled in the moderate-severe group. There were significant differences in left ventricular end-diastolic dimension (LVDd) (Z=-2.569, P=0.010), left ventricular end-systolic dimension (LVDs) (Z=-2.813, P=0.005), ventricular septal thickness (IVST) (Z=-3.389, P=0.001), left ventricular posterior wall thickness (LVPWT) (Z=-2.463, P=0.014) and the peak of early diastolic flow velocity E /the peak of atrial flow velocity A (Z=-3.483, P＜0.001) between normal mild-group and moderate-severe group. Plasma Hcy level was negatively correlated with LVDd (r=-0.206, P=0.006), LVDs (r=-0.190, P=0.011) and E/A (r=-0.234, P=0.002), positively correlated with IVST (r=0.356, P＜0.001) and LVPWT (r=0.243, P=0.001). Multiple regression analysis showed that plasma Hcy level was correlated with LVDd  (β=-0.263, P＜0.001), LVDs  (β=-0.223, P=0.004), IVST (β=0.294, P＜0.001), LVPWT   (β=0.244, P=0.002) independently. Plasma Hcy level interacted with body mass index (BMI) (β=0.405, P＜0.001) on IVST；Plasma Hcy level interacted with gender (β=-0.164, P=0.038), BMI (β=0.386, P＜0.001) and systolic blood pressure (SBP) (β=0.225, P=0.004) on LVPWT.  Conclusion  Hyperhomocysteinemia was an independent risk factor for cardiac structure changes in MHD patients, and there was an interaction between blood Hcy level and gender, BMI, and SBP before dialysis on cardiac structure changes.

【Key word】Maintenance hemodialysis; Homocysteine; Cardiac structure