Assessing plasma total homocysteine in patients with end-stage renal disease

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Biochemistry

Background:

• Elevated plasma total homocysteine (tHcy) is a recognized risk factor for cardiovascular disease (CVD).
• Patients with end-stage renal disease (ESRD) exhibit consistently high tHcy levels, with CVD being their primary cause of mortality.
• Recent randomized trials have questioned the causal link between tHcy and CVD.

Purpose of the Study:

• To review the evidence supporting the homocysteine theory of atherosclerosis.
• To examine homocysteine metabolism and toxicity mechanisms.
• To discuss clinical investigations and challenges in lowering tHcy in ESRD patients.

Main Methods:

• Literature review of early evidence on the homocysteine theory of atherosclerosis.
• Analysis of homocysteine metabolism and toxicity.
• Review of clinical trials and studies on peritoneal dialysis patients.
• Exploration of novel methods for tHcy reduction in ESRD.

Main Results:

• The review covers the historical evidence for homocysteine's role in atherosclerosis.
• Mechanisms of homocysteine toxicity are discussed.
• Clinical data, including sparse evidence in peritoneal dialysis, are presented.
• Difficulties in lowering tHcy in ESRD are highlighted.

Conclusions:

• The causality of tHcy as a CVD risk factor remains under investigation.
• Novel strategies are needed to effectively lower tHcy in ESRD patients.
• Clinicians and scientists should await results from the FAVORIT trial for definitive conclusions on homocysteine as a modifiable CVD risk factor.