Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease

Gherardo Buccianti, Ivano Baragetti, Fabrizia Bamonti, Silvia Furiani, Valentina Dorighet, Cristina Patrosso

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Hyperhomocysteinemia is considered an independent risk factor for atherosclerosis in patients with normal renal function. Plasma homocysteine (Hcy) is increased in patients with chronic renal failure (CRF) and could be linked to their high cardiovascular (CV) morbidity and mortality. We prospectively studied 77 patients (47 males and 30 females aged 62.85 ± 1.53 yrs) who had been on maintenance hemodialysis (HD) (4 hr/×3/week) for 65.5 ± 7.23 months. Patients were followed-up for 44 months. At baseline, blood samples were taken for hemoglobin (Hb), total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, serum calcium, serum phosphates, parathyroid hormone (PTH), Hcy, vitamin B12, serum and erythrocyte folate and methylentetrahydrofolate-reductase (t-MTH-FR) genotype determination. Plasma Hcy levels of patients were divided into four quartiles. The univariate analysis demonstrated a significant relationship between Hcy and diastolic blood pressure (BP) (r=0.45; p=0.003), and both plasma (r=-0.30; p=0.03) and erythrocyte (r=-0.48; p=0.01) folate levels and CV score (r=0.39; p=0.007). Kaplan-Meier analysis showed that the mortality rate due to CV events was statistically significantly higher in the 4th Hcy quartile (68%; 12 patients) vs. the 3rd quartile (12%; two patients), the 2nd quartile (28%; four patients) and the 1st quartile (14%; two patients) (log-rank test p=0.02). Cox's regression analysis for CV survival showed that Hcy was a positive CV mortality predictor (β=0.02; hazard ratio=1.031; 95% confidence interval (95% CI): 1.013-1.050; p=0.001), while LDL cholesterol and albumin related negatively to CV mortality (LDL cholesterol: β=-0.02; hazard ratio=0.095; 95% CI: 0.0957-0.0997; p=0.035; albumin: P=-2.35; hazard ratio=0.097; 95% CI: 0.011-0.847; p=0.026). Our results show that Hcy is a strong independent mortality predictor in HD patients with a 3% increase in mortality for each 1 μmol/L increase in plasma Hcy concentration. This agrees with previous findings confirming the role of Hcy in predicting CV risk factors in uremic patients.

Original languageEnglish
Pages (from-to)405-410
Number of pages6
JournalJournal of Nephrology
Volume17
Issue number3
Publication statusPublished - May 2004

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Homocysteine
Chronic Kidney Failure
Mortality
LDL Cholesterol
Confidence Intervals
Folic Acid
Renal Dialysis
Albumins
Erythrocytes
Serum
Calcium Phosphates
Blood Pressure
Hyperhomocysteinemia
Kaplan-Meier Estimate
Vitamin B 12
Parathyroid Hormone
HDL Cholesterol
Atherosclerosis
Oxidoreductases
Hemoglobins

Keywords

  • Cardiovascular risk
  • Homocysteine
  • Uremia

ASJC Scopus subject areas

  • Nephrology

Cite this

Buccianti, G., Baragetti, I., Bamonti, F., Furiani, S., Dorighet, V., & Patrosso, C. (2004). Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease. Journal of Nephrology, 17(3), 405-410.

Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease. / Buccianti, Gherardo; Baragetti, Ivano; Bamonti, Fabrizia; Furiani, Silvia; Dorighet, Valentina; Patrosso, Cristina.

In: Journal of Nephrology, Vol. 17, No. 3, 05.2004, p. 405-410.

Research output: Contribution to journalArticle

Buccianti, G, Baragetti, I, Bamonti, F, Furiani, S, Dorighet, V & Patrosso, C 2004, 'Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease', Journal of Nephrology, vol. 17, no. 3, pp. 405-410.
Buccianti G, Baragetti I, Bamonti F, Furiani S, Dorighet V, Patrosso C. Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease. Journal of Nephrology. 2004 May;17(3):405-410.
Buccianti, Gherardo ; Baragetti, Ivano ; Bamonti, Fabrizia ; Furiani, Silvia ; Dorighet, Valentina ; Patrosso, Cristina. / Plasma homocysteine levels and cardiovascular mortality in patients with end-stage renal disease. In: Journal of Nephrology. 2004 ; Vol. 17, No. 3. pp. 405-410.
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