Prevalence and Determinants of Hyperhomocysteinemia in Patients with Chronic Renal Failure / 대한신장학회잡지

ABSTRACT

BACKGROUND: Hyperhomocysteinemia plays an important role in atherosclerosis resulting from endothelial dysfunction and injury followed by platelet activation and thrombus formation. We evaluated the prevalence and determinants of hyperhomocysteinemia in patients with chronic renal failure(CRF) and relationship between hyperhomocysteinemia and cardiovascular diseases. METHODS: We evaluated the prevalence of hyperhomocysteinemia in CRF patients and hemodialysis patients. Fasting plasma homocysteine, vitamin B12, vitamin B6, creatinine, fibrinogen, lipoprotein(a), glucose, total cholesterol, HDL cholesterol, and TG levels were assessed in 69 patients. RESULTS: Hyperhomocysteinemia was detected 5% in controls, 86% in CRF groups, and 85% in hemodialysis group. Serum folate value in hemodialysis group was significantly higher than normal controls (10.7+/-4.8 vs. 15.3+/- 5.4nmoL/L; p<0.05). Plasma homocysteine concentration negatively correlated with serum folate level in hemodialysis patients(r=-0.42, p<0.05). Cardiovascular diseases were deteceted 14% in CRF patients and 25% in hemodialysis patients. Matched odds ratios(with 95% confidence intervals) were respectively 118.75, 107.7 for homocysteine in CRF and hemodialysis patients compaired with control group. CONCLUSION: Plasma homocysteine level correlated negatively with serum folate level in hemodialysis patients. In univariate analysis, determinant of plasma homocysteine concentration in hemodialysis patients is plasma folate concentration. We considered that hyperhomocysteinemia is also an independent risk factor of cardiovascular diseases.