Background/Purpose: Hyperhomocysteinemia is one of the important factors for the endothelial cell damage and also a risk factor for cardiovascular events. Gout is known to be associated with cardiovascular disease (CVD) as well. Although both hyperhomocysteinemia and gout are related to CVD, the only few cases about serum homocysteine (Hcy) in gouty patients have been reported. In this study, we investigated the associations between serum Hcy level and the other parameters including serum uric acid level, renal function, and cholesterol profiles in chronic gouty patients with longitudinal follow-up data.

Methods: Ninety-one male patients with chronic gout and 97 age-matched healthy male controls were included in this study, and the average age of each was 51.19 ± 15.08 and 51.57 ± 17.01 years old, respectively. Among them, 33 patients with gout and 39 healthy controls underwent follow-up tests for Hcy levels with 24.00 ± 9.12 months on average. Serum Hcy levels were measured by a competitive immunoassay using direct chemiluminescent. The estimated glomurular filtration rate (eGFR) was calculated using modification of diet in renal disease equation, and then chronic kidney disease (CKD) was defined as an eGFR below 60 ml/min/1.73m².

Results: In the serum uric acid level, there was no significant difference between chronic gouty patients and controls (6.15 ± 2.23 mg/dL vs 5.82 ± 1.22 mg/dL, p = 0.214). In contrast, gouty patients showed significantly higher levels in serum Hcy than those in controls (13.96 ± 4.05 μmol/L vs 12.67 ± 3.51 μmol/L, p = 0.022). In patients with chronic gout, serum Hcy level was negatively correlated with eGFR (γ= -0.413, p < 0.001), while it was uncorrelated with serum uric acid levels or cholesterol profiles. Serum Hcy levels were not different between the groups treated with allopurinol and with benzbromarone. When we observed the follow-up results in chronic gouty group, the change of serum Hcy level was positively correlated with the change of serum creatinine level (γ = 0.560, p < 0.001), and negatively correlated with the change of eGFR (γ = -0.556, p < 0.001). However the change of serum Hcy level was uncorrelated with the changes of uric acid level or the lipid profiles. The chronic gouty patients with CKD showed significantly higher serum Hcy level than those without CKD (17.45 ± 4.68 μmol/L vs 13.15 ± 3.46 μmol/L, p < 0.001), and the follow-up result also showed similar tendency (19.12 ± 4.29 μmol/L vs 15.69 ± 5.73 μmol/L, p = 0.059). In multiple linear analyses, serum Hcy level was affected by eGFR (β = -0.385, p< 0.001), however, was not affected by the serum uric acid level.

Conclusion: Serum Hcy level was elevated in chronic gouty patients than in controls. The change of serum Hcy level was negatively correlated with the change of eGFR. Hyperhomocysteinemia in chronic gouty patients was related with decreased renal function, and was not with serum uric acid or lipid profiles.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-serum-homocysteine-uric-acid-and-renal-function-in-chronic-gouty-patients-2-year-follow-up-results/