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Hyperhomocysteinemia predicts cardiovascular outcomes in hemodialysis patients
Francesca Mallamaci1, Carmine Zoccali, Giovanni Tripepi
1CNR Centro Fisiologia Clinica e Divisione di Nefrologia, Ospedali Riuniti, Reggio Calabria, Italy.
Insights
High homocysteine levels predict cardiovascular events in hemodialysis patients. This suggests hyperhomocysteinemia may contribute to cardiovascular damage in this population.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Prospective study of 175 hemodialysis patients.
- Follow-up duration of 29 +/- 12 months.
- Investigated prediction of homocysteine for clinical outcomes.
Purpose of the Study:
- To evaluate the predictive power of homocysteinemia for all-cause and cardiovascular outcomes.
- To assess the association between homocysteine levels and cardiovascular mortality and atherothrombotic events.
Main Methods:
- Survival analysis using Cox's proportional hazard model.
- Data expressed as hazard ratio and 95% confidence interval (CI).
Main Results:
- Plasma total homocysteine independently predicted cardiovascular mortality (P=0.01).
- Patients in the highest homocysteine tertile had 8.2 times higher risk of fatal/non-fatal atherothrombotic events (P=0.005).
- 51 deaths occurred, 61% cardiovascular; 16 non-fatal atherothrombotic events.
Conclusions:
- Hyperhomocysteinemia is clearly associated with incident cardiovascular mortality and atherothrombotic events in hemodialysis patients.
- Further intervention studies are required to establish a causal role for homocysteine in cardiovascular damage.
Background:
We prospectively tested the prediction power of homocysteinemia for all-cause and cardiovascular outcomes in a cohort of 175 hemodialysis patients followed for 29 +/- 12 months.
Methods:
Survival analysis was performed by the Cox's proportional hazard model and data were expressed as hazard ratio and 95% confidence interval (CI).
Results:
During the follow-up period 51 patients died, 31 of them (61%) of cardiovascular causes and 16 patients developed non-fatal atherothrombotic complications. Plasma total homocysteine was an independent predictor of cardiovascular mortality (P=0.01). Combined analysis of fatal and non-fatal atherothrombotic events showed that homocysteine was a strong and independent predictor of these outcomes because the risk of these events was 8.2 times higher (95% CI 1.9 to 32.2) in patients in the third homocysteine tertile than in those in the first tertile (P=0.005).
Conclusions:
There is a clear association between hyperhomocysteinemia and incident cardiovascular mortality and atherothrombotic events in hemodialysis patients. Intervention studies are needed to determine whether the accumulation of this substance has a causal role in the pathogenesis of cardiovascular damage in patients undergoing hemodialysis.