Non-traditional cardiovascular disease risk factors in end-stage renal disease: oxidate stress and hyperhomocysteinemia

Studies in experimental animals have shown that oxidative stress and hyperh omocyst(e)inemia culminate in abnormal vascular and endothelial regulation, functional nitric oxide deficiency, vascular hypertrophy, and atherosclero sis, Oxidative stress is accompanied by increased advanced glycation endpro ducts and oxidized low density lipoproteins. Studies of patients with end-s tage renal disease provide extensive indirect, evidence of increased oxidat ive stress and more than ninety percent are hyperhomocyt(e)inemic. Presentl y, only uncontrolled or observational studies are available to assess the e ffects of anti-oxidant therapy for oxidative stress or folate therapy for h yperhomocyst(e)inemia in these patients. Promising developments include the reports of beneficial effects of a vitamin E coated dialyzer, and the redu ction in homocyst(e)ine levels in patients with end-stage renal disease giv en an intravenous folate metabolite. However, there is presently no therapy available to reverse fully oxidative stress or hyperhomocyst(e)inemia. The refore, the causative role of these nontraditional risk factors of cardiova scular disease remains untested. Curr Opin Nephrol Hypertens 9:477-487. (C) 2000 Lippincott Williams & Wilkins.