Hyperhomocysteinemia in end stage renal disease: a risk factor for atherosclerotic and/or thromboembolic complications?

To clarify the association of hyperhomocysteinemia with the increased risk of atherosclerotic and thromboembolic vascular complications in patients with end stage renal disease [ESRD] independent of other traditional risk factors, this study was performed. It included 150 patients with established ESRD scheduled on chronic ambulatory peritoneal dialysis [CAPD] or regular hemodialysis using high-flux membrane. All patients were supplemented with multivitamins including B12, B6 and folic acid. These patients were divided into two groups: Group A included 26 patients with clinically documented peripheral vascular events [ten with deep venous thrombosis and 16 with peripheral arterial disease] and group B included 124 patients without any clinically or laboratory documented vascular disease. In addition, 30 apparently healthy individuals were included as a control group. Total fasting plasma homocysteine as well as other risk factors were determined including hypertension, obesity, smoking, diabetes mellitus, hyperuricemia, dyslipidemia, prolonged recumbency and recent operations or trauma. Biochemical analyses were done including blood glucose levels [fasting and 2-hour postprandial], lipid profile [total cholesterol, triglycerides, HDL, LDL], serum uric acid, BUN and creatinine. Hematological analyses were also done including complete blood count, prothrombin time and concentration, aPTT, protein C, protein S, antithrombin III as well as fibrinogen. Imaging was also performed in the form of duplex ultrasound for peripheral arterial and/or venous systems and/or angiography in the selected cases. It was concluded that hyperhomocysteinemia is frequently seen in ESRD patients and it represents an independent risk factor for the atherosclerotic and thrombotic vascular disorders which occur frequently in these patients. It is higher in hemodialysis patients than in those on chronic ambulatory peritoneal dialysis [CAPD]