HYPERHOMOCYSTEINEMIA AND THE RISK FOR VASCULAR-DISEASE IN HEMODIALYSIS-PATIENTS

The objective of this study was to examine if hyperhomocysteinemia is associated with occlusive vascular disease in hemodialysis patients, T he study design included risk factor analysis and determination of ser um homocysteine in hemodialysis patients, Fifty chronic uremic patient s on regular hemodialysis treatment were studied, Twenty-four patients had coronary, cerebral, or peripheral signs of occlusive vascular dis ease. Cerebral vascular disease was diagnosed by computed tomography, arterial angiography, or Doppler sonography of the carotid and vertebr al arteries. Coronary vascular disease was diagnosed by documented his tory of myocardial infarction or by coronary angiography, The diagnosi s of peripheral vascular disease was established by angiography of the lower limb arteries. In all control patients, Doppler sonography of t he carotid, vertebral, and lower limb arteries and thallium-201 exerci se imaging were without pathologic results, Measurements included bloo d pressure, body mass index, smoking behavior, serum homocysteine (mea sured by gas chromatography/mass spectrometry), serum total, low-densi ty lipoprotein, and high-density lipoprotein cholesterol, lipoprotein (a), triglycerides, and plasma fibrinogen. In a stepwise multiple logi stic regression analysis, high serum homocysteine was significantly as sociated with occlusive arterial disease (R = 0.23; P = 0.031). Furthe rmore, hypertension (R = 0.18; P = 0.058), but not serum total, low-de nsity lipoprotein, and high-density lipoprotein cholesterol, lipoprote in (a), triglycerides, diabetes mellitus, body mass index, plasma fibr inogen, and smoking behavior, was significantly associated with athero sclerosis. Our results support the hypothesis that hyperhomocysteinemi a is an independent risk factor for vascular disease in hemodialysis p atients.