Homocysteine and carotid atherosclerosis in chronic renal failure--the confounding effect of renal function

Area of Science:

• Nephrology
• Cardiology
• Vascular Biology

Background:

• Elevated total homocysteine (tHcy) is a known risk factor for cardiovascular disease (CVD).
• Patients with chronic renal failure (CRF) exhibit markedly elevated tHcy levels.
• The role of tHcy in atherosclerosis within the CRF population requires further investigation.

Purpose of the Study:

• To investigate the association between elevated tHcy levels and carotid atherosclerosis in patients with CRF.
• To compare the predictive value of tHcy against traditional cardiovascular risk factors for carotid atherosclerosis in CRF.
• To assess the relationship between tHcy and atherosclerosis across different stages of renal disease.

Main Methods:

• Cross-sectional study involving 135 CRF patients (predialysis, dialysis, transplant recipients) and 58 controls.
• Assessment of common carotid artery intima-media thickness (IMT) and carotid artery plaque score.
• Analysis of the association between tHcy levels, classic cardiovascular risk factors, and carotid atherosclerosis markers.

Main Results:

• No significant association was found between tHcy levels and carotid IMT or plaque score in CRF patients.
• Elevated tHcy did not consistently correlate with coronary, cerebrovascular, or peripheral arterial disease.
• Renal function (creatinine clearance) was the primary determinant of tHcy levels.
• Age, hypertension duration, and elevated LDL cholesterol were significant predictors of carotid atherosclerosis.

Conclusions:

• This study indicates no direct association between total homocysteine levels and carotid atherosclerosis in patients with chronic renal failure.
• Traditional cardiovascular risk factors like age, hypertension, and dyslipidemia are stronger predictors of atherosclerosis in CRF.
• The confounding effect of fluctuating renal function may complicate the assessment of tHcy's role in CVD risk in CRF patients.