title: Association between homocysteine status and the risk of nephropathy in type 2 diabetes mellitus.
abstract: BACKGROUND
  It is well documented that hyperhomocysteinemia induces renal injury. However, the association between homocysteine level and type 2 diabetic nephropathy (T2DN) remains elusive.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Seven 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital, Nanjing, China.
authors.forename: Song
authors.initials: S
authors.lastname: Mao
authors.affiliation: Sanatorium of Nanjing Jinling Hospital, 305 Zhongshan Road, Nanjing, Jiangsu Province 210008, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xiang
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital, Nanjing, China.
authors.forename: Songming
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Nephrology, Nanjing Children's Hospital, Nanjing, China. Electronic address: edjh123456@126.com.
authors.forename: Aihua
authors.initials: A
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
keywords: Diabetic nephropathy; Homocysteine; Meta-analysis; Risk