Is homocysteine a risk factor for the incidence of coronary artery diseaseto patients with end-stage renal disease?

Background: Cardiovascular disease is a major cause of mortality in chronic uremic patients. We studied whether homocysteine is an independent cardiov ascular risk factor for patients with end-stage renal disease (ESRD). Patients and Methods: The study included 163 patients and controls (Group 1 : healthy controls, n = 20; Group 2: patients with chronic renal failure, s erum creatinine less than or equal to 4 mg/dl, n = 23: Group 3: patients wi th ESRD, n = 91; Group 4: renal transplant recipients serum creatinine less than or equal to 2.5 mg/dl, n = 29). We registered patients for the follow ing factors: age, diabetes, smoking, lipids, vitamin B-12, folic acid and h omocysteine. The coronary heart disease was diagnosed by coronaryangiograph y. Results: The cardiovascular risk profile (hypertension, diabetes, smoking, hyperlipidemia) among uremic patients was significantly increased compared to the healthy controls. there was a significant correlation between the im pairment of renal function and the increase of the homocysteine concentrati on (Group 1: 12 +/- 4.3 mu mol/l vs Group 3: 27.8 +/- 15.8 mu mol/l: p < 0. 001). There was no significant difference of homocysteine between the patie nts with coronary heart disease and those without (29.9 +/- 18.1 mu mol/l v s 26.6 +/- 14.4 mu mol/l, not significant). Conclusion: In This study a significant correlation between the number of c ardiovascular risk factors and the incidence of cardiovascular disease was proven. Although homocysteine was increased among patients with impaired re nal function hyperhomocysteinemia could not be identified as a significant risk factor for coronary heart disease in patients with ESRD. It is assumab le that the pathogenesis of coronary heart disease in patients with ESRD is of multifactoral origin.