Hyperhomocysteinaemia and end stage renal disease

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A Gupta1, K Robinson

  • 1Department of Internal Medicine and Cardiology, Cleveland Clinic Foundation, Ohio, USA.

Journal of Nephrology
|March 1, 1997
PubMed

Insights

High homocysteine levels are common in end-stage renal disease patients, increasing vascular disease risk. Supplementing with B vitamins can lower homocysteine, but their impact on vascular risk requires further investigation.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Vascular disease significantly impacts morbidity and mortality in end-stage renal disease (ESRD) patients.
  • Traditional atherosclerosis risk factors do not fully explain the high prevalence of vascular disease in ESRD.
  • Elevated plasma homocysteine is a recognized risk factor for vascular disease and is frequently observed in ESRD patients.

Purpose of the Study:

  • To investigate the relationship between hyperhomocysteinemia and vascular disease in ESRD.
  • To explore potential causes of hyperhomocysteinemia in ESRD, including altered homocysteine metabolism and vitamin deficiencies.
  • To assess the efficacy of vitamin supplementation in reducing homocysteine levels and its potential impact on vascular risk.

Main Methods:

  • Review of existing studies on homocysteine levels in ESRD patients.
  • Analysis of factors contributing to hyperhomocysteinemia, including renal metabolism and vitamin status (folate, B6, B12).
  • Examination of studies involving homocysteine reduction through vitamin administration (folic acid, B12, B6).

Main Results:

  • Hyperhomocysteinemia is an independent risk factor for atherosclerosis in ESRD patients.
  • While vitamin supplementation (folic acid, B12, B6) can reduce plasma homocysteine concentrations, the underlying causes of hyperhomocysteinemia in ESRD remain complex.
  • High vitamin levels do not always correlate with reduced homocysteine, suggesting altered metabolism or intracellular vitamin activity.

Conclusions:

  • Hyperhomocysteinemia is a significant, independent risk factor for vascular disease in end-stage renal disease.
  • Reducing homocysteine levels through vitamin supplementation is feasible, but its clinical benefit on vascular outcomes in ESRD needs further research.

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