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Association between plasma homocysteine concentration and carotid atherosclerosis in hemodialysis patients
T Sakurabayashi1, M Fujimoto, Y Takaesu
1Kidney Center, Shinraku-en Hospital, Niigata, Japan. fm6y-kud@asahi-net.or.jp
Insights
High homocysteine levels (tHcy) in hemodialysis patients are linked to accelerated atherosclerosis. Advanced age, systolic hypertension, and smoking also significantly worsen this condition, impacting cardiovascular health.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Accelerated atherosclerosis is a significant complication for patients on long-term hemodialysis.
- Hyperhomocysteinemia is a potential contributing factor to atherosclerosis in this population.
Purpose of the Study:
- To investigate the association between plasma total homocysteine concentration (tHcy) and cardiovascular risk factors in hemodialysis patients.
- To determine the relationship between tHcy and the extent of generalized atherosclerosis.
Main Methods:
- 168 hemodialysis patients were assessed for plasma tHcy levels.
- Carotid artery intimal-medial wall thickness (IMT) was measured using B-mode ultrasonography to indicate atherosclerosis.
- Multiple regression analysis was employed to identify factors associated with carotid IMT.
Main Results:
- Hemodialysis patients exhibited significantly higher tHcy levels (33.0+/-16.9 micromol/L) compared to healthy subjects.
- Carotid maximum IMT was significantly associated with age, systolic blood pressure, smoking, duration of hemodialysis, and tHcy.
- These five factors explained 36.0% of the variation in carotid maximum IMT.
Conclusions:
- Hyperhomocysteinemia is a significant risk factor for accelerated atherosclerosis in chronic uremic patients.
- The combination of hyperhomocysteinemia, advanced age, systolic hypertension, and smoking exacerbates atherosclerosis in this vulnerable group.
- Factors such as gender, diastolic blood pressure, and lipid profiles were not found to be significantly related to atherosclerosis in this study.
Abstract:
Accelerated atherosclerosis is a major risk for uremic patients undergoing long-term hemodialysis. Because hyperhomocysteinemia may influence this condition, 168 such patients were examined for a possible association between plasma total homocysteine concentration (tHcy) and conventional cardiovascular risk factors. Generalized atherosclerosis was indicated by excessive intimal-medial wall thickness (IMT) of the extracranial carotid artery as measured by B-mode ultrasonography. The results documented tHcy in these patients of 33.0+/-16.9 micromol/L, a significantly higher amount than that of healthy subjects (11.0+/-3.1 micromol/L, p<0.0001). The patients' carotid maximum IMT was 1.79+/-1.16 mm. In multiple regression analyses with forward elimination procedure, carotid maximum IMT was clearly related to age (r = 0.417, p<0.0001), systolic blood pressure (r = 0.262, p = 0.0043), smoking (r = 0.177, p = 0.0076), duration of hemodialysis (r = 0.083, p = 0.0045), and tHcy (r = 0.195, p = 0.0021). These 5 factors accounted for 36.0% of the variation in carotid maximum IMT. Factors determined as unrelated were male gender, diastolic blood pressure, body mass index, total and HDL cholesterol, triglyceride, lipoprotein(a), uric acid, calcium, inorganic phosphate, and parathyroid hormone. Therefore hyperhomocysteinemia, along with advanced age, systolic hypertension and smoking aggravates atherosclerosis in chronic uremic patients.