Homocysteine Levels in Chronic Kidney Disease Patients in Gaza Governorate, Gaza Strip

Abstract

Background: chronic kidney disease (CKD) is one of the leading cause of death among the Palestinians. Although hyperhomocysteinemia has been strongly linked to CKD, biochemical tests are restricted to monitoring kidney function test . Therefore, introducing homocysteine test in Gaza hospitals for CKD patients may provide a clearer picture on the patient condition and help in the disease management. Objective: To assess homocysteine status and some biochemical parameters of CKD in patients from Gaza Governorate, Gaza Strip. Material and methods: This case-control study comprised 82 CKD patients and 82 healthy controls. Questionnaire interview was applied. Serum homocysteine, urea, creatinine, uric acid, protein profile, and electrolytes were determined . Data were analyzed using SPSS version 18.0. Results: The mean ages of controls and cases were 44.8±10.2 and 45.7±13.6 years, respectively. CKD was more frequent among lower educated and unemployed individuals as well as among families with low income (P<0.05). BMI of cases was significantly higher than that of controls (30.6±6.8 vs. 25.6±3.7, and P=0.000). Clinical data showed that hypertension, diabetes and obesity are risk factors of CKD. Among food stuff, only frequent consumption of meat was found to be a risk factor of CKD. The mean levels of homocysteine was significantly higher in cases compared to controls ((27.8±5.7 vs. 13.4±3.7 µmol/l, P=0.000). The average levels of urea, creatinine and uric acid were found to be significantly higher in cases (114.1±40.3, 4.9±2.8 and 6.1±1.8 mg/dl, respectively) compared to controls (26.0±7.5, 0.69±0.12 and 4.3±1.1 mg/dl,) with P=0.000. In contrast, the mean value of Glomerular Filtration Rate (GFR) was markedly declined in cases compared to controls (19.3±15.0 vs. 125.5±22.7, p=0.000). There was a significant decrease in the mean level of total proteins in cases compared to controls (6.8±0.6 vs. 7.1±0.3, p=0.021). Homocysteine levels were higher in low educated, unemployed, and low family income (P=0.000). Homocysteine levels were also higher in hypertensive, diabetic and obese individuals as well as in individuals who ate meat frequently (P<0.05). Homocysteine levels were positively correlated with BMI (r=0.291, P=0.006), urea (r=0.698, P=0.000), creatinine (r=0.674, P=0.000), uric acid (0.471, P=0.000), potassium (r=0.643, P=0.000 ) and phosphorus (r=0.467, P=0.000) and negatively correlated with GFR (r=-0.793, P= 0.000), total protein (r=-0.255, P=0.016) and calcium (r=-0.420, P=0.000). Conclusions: Serum homocysteine level were significantly higher in CKD patients compared to controls. Homocysteine levels in CKD patients were higher in low educated and unemployed individuals as well as family with low income. Hypertensive, diabetic and obese individuals as well as individuals who ate meat frequently had also higher levels of homocysteine. Homocysteine levels were positively correlated with BMI, urea, creatinine, uric acid, potassium and phosphorous, and negatively correlated with GFR, total protein and calcium.