Hyperhomocyst(e)inemia and the prevalence of atherosclerotic vascular disease in patients with end-stage renal disease

Hyperhomocyst(e)inemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal functi on. Hyperhomocyst(e)inemia is common in patients with chronic renal failure . This study is designed to look for an association between hyperhomocyst(e )inemia and atherosclerotic vascular disease in patients with end-stage ren al disease (ESRD). Two hundred eighteen patients undergoing hemodialysis we re enrolled onto the study and had predialysis bloodwork performed for tota l homocyst(e)ine, red blood cell folate, and vitamin B-12 levels. A history of clinically significant atherosclerotic vascular disease (ischemic heart disease, cerebrovascular disease, or peripheral vascular disease) was elic ited by patient questionnaire and verified by careful inpatient and outpati ent chart review. Atherosclerotic vascular disease was present in 45.9% of patients. Mean homocyst(e)ine concentration was 26.7 mu mol/L (95% confiden ce interval [CI], 25.0 to 28.4) overall. Mean homocyst(e)ine concentration was 28.6 mu mol/L (95% CI, 25.6 to 31.7) and 25.0 mu mol/L (95% CI, 23.2 to 26.8) in patients with and without atherosclerotic disease, respectively ( P = 0.036). The adjusted odds ratio for atherosclerotic disease was 2.12 (9 5% CI, 1.03 to 4.39) for those subjects with a homocyst(e)ine level in the highest quartile compared with the lowest 3 quartiles. In the 126 men, the adjusted odds ratio for atherosclerotic disease was 3.4 (95% CI, 1.24 to 9. 42) for those with homocyst(e)ine levels in the highest quartile compared w ith the lowest 3 quartiles. No association was found between homocyst(e)ine level and atherosclerotic disease in women. In conclusion, there is an ass ociation between hyperhomocyst(e)inemia and atherosclerotic vascular diseas e in patients undergoing dialysis. Prospective studies need to further exam ine the relationship between homocyst(e)ine level and atherosclerosis in wo men with ESRD. (C) 1999 by the National Kidney Foundation, Inc.