The normal total fasting plasma homocysteine levels range from 4 to 12.3 μmol/l 6. Homocysteine is filtered by the glomerulus however, it is almost completely (over 98%) reabsorbed by tubular cells in the kidneys 3. Both remethylation reactions are irreversible and require the active form of B vitamins as a cofactor 4, 5. There are two different remethylation pathways: the first remethylation pathway requires 5-methyltetrahydrofolate as a methyl donor, which is generated by a reaction catalyzed by 5,10-methylenetetrahydrofolate reductase (MTHFR) the second remethylation reaction uses betaine as a methyl donor in the transsulfuration pathway 2, 3. In the transsulfuration pathway, homocysteine combines with serine to form cystathionine then, cystathionine is hydrolyzed into cysteine and alpha-ketobutyrate 2. Homocysteine can be either degraded through the transsulfuration pathway or remethylated to methionine 2, 3. Homocysteine is a sulfur-containing, nonproteinogenic amino acid that is derived from transmethylation of the essential sulfur-containing amino acid methionine 1. In conclusion, homocysteine level is an independent risk factor associated with serum creatinine and BUN levels in male patients with hypertension. In contrast, only LVEF was positively associated with uric acid levels in females. Body mass index (BMI) was positively associated and hemoglobin A1c (HbA1c) levels, high density lipoprotein cholesterol (HDL-C) levels and the presence of stroke were negatively associated with serum uric acid levels in male patients. LDL-C levels and LVEF were negatively associated with BUN levels in females. Age was a common risk factor positively associated with BUN levels in both sexes, while total cholesterol (TC) levels and glycemic control were independent risk factors that were positively associated with BUN levels only in males. In addition, low density lipoprotein cholesterol (LDL-C) levels were positively and left ventricular ejection fraction (LVEF) was negatively associated with serum creatinine level in males age was positively associated with serum creatinine levels in females. Homocysteine levels were associated with serum creatinine and blood urea nitrogen (BUN) levels with coefficients of 2.04 and 0.07, respectively, only in males and independent of confounders. A cross-sectional study to show whether and how serum fasting homocysteine levels are associated with renal function changes in patients with hypertension.
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