Association between homocysteine status and the risk of nephropathy in type 2 diabetes mellitus

• The aim of this study was the evaluation of the alteration of plasma level of homocysteine in T2DN patients with macroalbuminuria or microalbuminuria compared with T2DM controls without albuminuria.
• The quality of studies included in this meta-analysis are median in terms of Newcastle–Ottawa Quality Assessment Scale.
• The status of plasma homocysteine is associated with the risk and severity of nephropathy in T2DM.
• The status of plasma homocysteine is a potential marker of the onset of nephropathy in T2DM.

BackgroundIt is well documented that hyperhomocysteinemia induces renal injury. However, the association between homocysteine level and type 2 diabetic nephropathy (T2DN) remains elusive.MethodsWe evaluated the alteration of plasma level of homocysteine in T2DN patients with macroalbuminuria or microalbuminuria compared with type 2 diabetes mellitus (T2DM) controls without albuminuria by performing a meta-analysis. We searched the PubMed, Embase and Cochrane databases from January 1990 to October 2013 to identify studies that met predefined criteria.ResultsSeven studies were included in this investigation. T2DN patients with macroalbuminuria demonstrated a significantly higher level of plasma homocysteine than T2DM without albuminuria (4 studies, random effects SMD: 1.66, 95% CI: 0.46 to 2.87, P = 0.007) and T2DN with microalbuminuria (3 studies, random effects SMD: 0.99, 95% CI: 0.62 to 1.36, P < 0.001). T2DN patients with microalbuminuria demonstrated significantly higher level of plasma homocysteine than T2DM without albuminuria (6 studies, random effects SMD: 1.29, 95%.CI: 0.59 to 2, P < 0.001). Exclusion of any single study had little impact on the pooled SMDs. No evidence of publication bias was observed.ConclusionsOur findings indicate that the status of plasma homocysteine is associated with both the risk and severity of nephropathy in T2DM. Frequent monitoring and early intervention should be recommended.