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[Is homocysteine a risk factor for coronary heart disease in patients with terminal renal failure?]
A Klusmann1, K Ivens, P Schadewaldt
1Klinik für Nephrologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf.
Insights
Homocysteine levels increase with declining kidney function in end-stage renal disease (ESRD) patients. However, this study found hyperhomocysteinemia is not a significant independent risk factor for coronary heart disease in ESRD.
Area of Science:
- Nephrology
- Cardiology
- Clinical Biochemistry
Context:
- Cardiovascular disease (CVD) is a leading cause of mortality in patients with chronic kidney disease (CKD).
- Elevated homocysteine levels are implicated as a potential cardiovascular risk factor.
- The role of homocysteine in CVD among end-stage renal disease (ESRD) patients requires further investigation.
Purpose:
- To investigate whether homocysteine is an independent cardiovascular risk factor in patients with end-stage renal disease (ESRD).
Summary:
- This study analyzed 163 participants, including healthy controls and patients with varying degrees of renal impairment (CKD and ESRD).
- Researchers measured homocysteine levels, alongside traditional cardiovascular risk factors, and assessed coronary heart disease incidence via angiography.
- Results showed a significant correlation between impaired renal function and increased homocysteine levels, but no significant association between homocysteine and coronary heart disease in ESRD patients.
Impact:
- The findings suggest that while homocysteine is elevated in ESRD, it may not be a primary driver of coronary heart disease in this population.
- This highlights the multifactorial nature of CVD pathogenesis in ESRD.
- Further research into other contributing factors is warranted for effective CVD prevention and management in ESRD patients.
Background:
Cardiovascular disease is a major cause of mortality in chronic uremic patients. We studied whether homocysteine is an independent cardiovascular risk factor for patients with end-stage renal disease (ESRD).
Patients And Methods:
The study included 163 patients and controls (Group 1: healthy controls, n = 20; Group 2: patients with chronic renal failure, serum creatinine < or = 4 mg/dl, n = 23; Group 3: patients with ESRD, n = 91; Group 4: renal transplant recipients, serum creatinine < or = 2.5 mg/dl, n = 29). We registered patients for the following factors: age, diabetes, smoking, lipids, vitamin B12, folic acid and homocysteine. The coronary heart disease was diagnosed by coronary angiography.
Results:
The cardiovascular risk profile (hypertension, diabetes, smoking, hyperlipidemia) among uremic patients was significantly increased compared to the healthy controls. There was a significant correlation between the impairment of renal function and the increase of the homocysteine concentration (Group 1: 12 +/- 4.3 mumol/l vs Group 3: 27.8 +/- 15.8 mumol/l; p < 0.001). There was no significant difference of homocysteine between the patients with coronary heart disease and those without (29.9 +/- 18.1 mumol/l vs 26.6 +/- 14.4 mumol/l, not significant).
Conclusion:
In this study a significant correlation between the number of cardiovascular risk factors and the incidence of cardiovascular disease was proven. Although homocysteine was increased among patients with impaired renal function, hyperhomocysteinemia could not be identified as a significant risk factor for coronary heart disease in patients with ESRD. It is assumable that the pathogenesis of coronary heart disease in patients with ESRD is of multifactorial origin.