PROSPECTIVE-STUDY OF HYPERHOMOCYSTEINEMIA AS AN ADVERSE CARDIOVASCULAR RISK FACTOR IN END-STAGE RENAL-DISEASE

Background-Retrospective and case-control studies show that hyperhomoc ysteinemia is an independent risk factor for atherosclerosis in patien ts with end-stage renal disease. We studied prospectively the associat ion between total homocysteine and cardiovascular outcomes. Methods an d Results-In all, 167 patients (93 men, 74 women; mean age, 56.3+/-14. 7 years) were followed for a mean duration of 17.4+/-6.4 months. Cardi ovascular events and causes of mortality were related to total homocys teine values and other cardiovascular risk factors. Cox regression ana lysis was used to identity the independent predictors for cardiovascul ar events and mortality. Fifty-five patients (33%) developed cardiovas cular events and 31 (19%) died, 12 (8%) of cardiovascular causes. Tota l plasma homocysteine values ranged between 7.9 and 315.0 mu mol/L. Le vels were higher in patients who had cardiovascular events or died of cardiovascular causes (43.0+/-48.6 versus 26.9+/-14.9 mu mol/L, P=.02) . The relative risk (KR) for cardiovascular events, including death, i ncreased 1% per mu mol/L increase in total homocysteine concentration (RR, 1.01; CI, 1.00 to 1.01: P=.01). Conclusions-These prospective obs ervations confirm that hyperhomocysteinemia is an independent risk fac tor for cardiovascular morbidity and mortality in end-stage renal dise ase, with an increased RR of 1% per mu mol/L increase in total homocys teine concentration. Interventional studies are needed to evaluate the possible effects of modifying this risk factor in these patients.