Relationship between Hyperhomocysteinemia and Atherosclerosis in Chronic Hemodialysis Patients
Puntapong Taruangsri, MD*, Leena Ong-Ajyooth, MD, Dr med*, Sompong Ong-Ajyooth, B Pharm, MSc**, Walailak Chaiyasoot, M D***, Wattana Leowattana, MD****, Suchai Sritippayawan, MD*, Kriengsak Vareesangthip, MD, PhD*, Thawee Chanchairujira, MD*, Somkiat Vasuvattakul, MD*, Chairat Shayakul, MD*, Supat Vanichakarn, MD*
Affiliation : * Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ** Department of Biochemistry, Faculty of Medicine, Siriraj Hospital, Mahidol University *** Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University **** Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University
Background : Hyperhomocysteinemia is an independent risk factor of coronary artery heart disease (CAHD)
and atherosclerosis in a normal population. However, it is still controversial in end-stage kidney disease
patients who underwent long-term dialysis. Carotid intima-media thickness (IMT) is the standard non-invasive
measurement of atherosclerosis. The aims of the present study were to determine the homocysteine (Hcy) level,
and to evaluate its role as a risk factor of atherosclerosis in hemodialysis (HD) patients.
Materials and Methods : Clinical data and blood chemistries were assayed in 62 HD patients. Atherosclerosis
was defined by clinical presentations of CAHD, cerebrovascular or peripheral vascular diseases, or carotid
plaque by ultrasound. IMT was also measured by ultrasound.
Results : Plasma Hcy level in HD patients was significantly higher in HD patients than normal controls (28.3
(cid:31) 8.3 vs 9.7 (cid:31) 2.9 µmol/l, p < 0.001). Older age (p < 0.001), male sex (p = 0.05), longer duration of HD (p =
0.05), and higher plasma Hcy level (p = 0.01) correlated with atherosclerosis by univariate analysis, but
plasma Hcy did not show significant correlation by multivariable analysis. There was also correlation between
IMT and atherosclerosis in HD patients (p < 0.001) but no correlation was observed between plasma Hcy level
and IMT.
Conclusion : Hyperhomocysteinemia is not an independent factor in the genesis of atherosclerosis in HD
patients. Advanced age plays a major role of hyperhomocysteinemia and IMT is a useful marker of atheroscle-
rosis in these patients.
Keywords : Homocysteine, Atherosclerosis, HD patients, Carotid intima-media thickness
