Résumé
The aim of this work was, to determine whether hyperhomocysteinemia and its metabolic consequences are associated with vascular access thrombosis in patients with end stage renal disease [ESRD], undergoing chronic hemodiahysis [HD]. This study included 3 groups. Group I: 15 ESRD patients on regular HD, with history of more than one episode of vascular access thrombosis. Group II: 15 ESRD patients on regular HD, with no episodes of vascular access thrombosis. Group III: 10 healthy, age and sex matched individuels as a control group. Plasma total homocysfeine [tHcy] and Von Willebrand Factor [vWF] were estimated by ELISA. Determination of plasma folate was done by Radioimmunoassay [RIA]. Plasma glutathione peroxidase activity was estimated by modified Paglia and Valentine method. Plasma methionine and cysteine levels were estimated by amino acid autoanalyser. plasma Hcy levels of both HD groups [GI and GII] were significantly higher than control groups [GIII] [F value = 44,487, P<0.0001], while no significant difference was found between GI and GII. Plasma folic acid levels of both patients' groups were significantly higher than control group [F value = 29.063, P<0.0001], while there was no significant difference between its level in GI and GII. Plasma vWF of HD patients with vascular access thrombosis [GI] was significantly higher than that of both GII and GIII and that of GII was significantly higher than GIII [F value = 62.010, P<0.0001]. Plasma glutathione peroxidase activity of both HD groups [GI and GII] was significantly lower than the control group [GIII] [F value = 69.446, P<0.0001], also its activity in patients with vascular access thrombosis [GI] was significantly lower than that of patients without vascular access thrombosis [GII]. Plasma cysteine and methionine levels of both HD groups were not significantly different from control group, also there was no significant difference in their levels between GI and GII. Plasma Hcy levels showed no significant correlation with number of vascular access thrombosis, whereas it showed a significant positive correlation with plasma vWF [r = 0.474, P<0.01] and negative correlation with plasma glutathione peroxidase activity [r = 0.643, P<0.0001]. From the previous study we concluded that: Hyperhomocyteinemia is not a direct cause of vascular access thrombosis. It is linked with increased plasma vWF levels. Endlothelial injury induced by hyperhomocysteinemia may be the cause. The lower levels of plasma glutathione peroxidase activity reflect increased oxidative stress induced by hyperhomocyteinemia in hemodialysis patients