CORRELATION OF SERUM HOMOCYSTEINE LEVELS WITH CAROTID ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Amol Bhawane, Shankar Lal Jat, O P Kalra, G S Ranga, Pratibha Maan

Abstract


INTRODUCTION: Chronic kidney disease (CKD) is associated with significantly increased morbidity and mortality.
Hyperhomocysteinemia (>15 μmol/l) is one of the such risk factors2 for CVD in CKD patients. Hyperhomocysteinemia is
observed in at least 85% patients with ESRD3. With this background in mind, the present study was designed to assess
severity of hyperhomocysteinemia in advanced stages of CKD and find a correlation between Hcy and carotid intima
media thickness in Indian population. To assess serum homocysteine levels in patients with stage 3, 4 and 5 CKD and
compare with healthy controls. To assess correlation of serum homocysteine levels with CIMT as determined by high
resolution carotid ultrasound.
METHODS: A total of 66 subjects aged 20-60 years were recruited and divided into the following groups . Group A –
healthy controls (n=22) Group B – stage 3 and 4 CKD (n=22) Group C – stage 5 CKD (n=22) on the basis of history,
physical examination, hematological and biochemical investigations (blood urea, serum creatinine and GFR values),
attending Medical OPD, Nephrology clinic, Medical Emergency or admitted in Medical Wards not meeting any of the
exclusion criteria were included in the study.
RESULTS: In our study mean serum homocysteine levels in group A was 9.1±3.37 μmol/l) with a median 8.16 μmol/l and
a range of 4.8-18.5 μmol/l, in group B mean homocysteine level was 22.0±3.10 μmol/l with a median 22.21 μmol/l and a
range of 16.2-28.0 μmol/l. in group C pre dialysis mean homocysteine level was 29.6±4.90 μmol/l with a median 29.68
μmol/l and range 21.0-37.7 μmol/l while in group C post dialysis mean homocysteine level was 23.0±4.20 μmol/l with a
Median 21.73 and range 17.2-30.1 μmol/l. Thus, homocysteine levels in CKD patients were significantly higher in (>4
times) than controls (p <0.000). In our study we tried to find out correlation between homocysteine and carotid intimamedia
thickness in various study groups. We found that serum homocysteine levels were higher in patients of CKD and
with increase in severity of renal disease, CIMT also showed an increase. There was positive correlation between serum
homocysteine level and CIMT (r=0.311) and this correlation was found to be statistically significant (p<0.001).
CONCLUSION:
Ÿ Mean serum homocysteine levels in CKD patients were significantly higher in (>4 times) than controls (p <0.000)
Ÿ There was positive correlation between serum homocysteine level and CIMT (r=0.311) and this correlation was
found to be statistically significant (p<0.001).


Keywords


Chronic Kidney Disease (CKD), Homocysteine, Carotid Intima Media Thickness

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References


United States Renal Data System. Annual Data Report 1998. Bethesda, MD,

National Institute of Health, National Institute of Diabetes and Digestive and

Kidney Disease 1998.

Robinson K, Mayer E, Jacobsen DW, et al. Homocysteine and coronary artery

disease. Cleve Clin J Med 1994; 61: 438-450.

Bostom AG, Culleton BF. Hyperhomocysteinemia in chronic renal disease. J

Am Soc Nephrol 1999; 10: 891-900.

Van Guldenr CV, Stam F, Stehouwer C, et al. Homocysteine metabolism in

renal failure. Kidney Int 2001; 59: 5234-5237.

Suliman ME, Anderstam B, Lindholm B, et al. Total, free and protein-bound

sulphur amino acids in uraemic patients. Nephrol Dial Transplant 1997; 12:

-2338.

Guttormsen AB, Ueland PM, Svarstad E, et al. Kinetic basis of

hyperhomocysteinemia in patients with chronic renal failure. Kidney Int 1997;

: 495-502.

Jungers P, Massy ZA, Nguyen Khoa T, et al. Incidence and risk factors of

atherosclerotic cardiovascular accidents in predialysis chronic renal failure

patients: a prospective study. Nephrol Dial Transplant 1997; 12: 2597-2602.

Mo u s t a p h a A , N a s o A , N a h l aw H , e t a l . P ro s p e c t ive s t u dy o f

hyperhomocysteinemia as an adverse cardiovascular risk factor in end stage

renal disease. Circulation 1999; 97: 138-141.

Nerbass FB, Draibe SA, Feiten SF, et al. Homocysteine and its determinants in

nondialyzed chronic kidney disease patients. J Am Diet Assoc 2006; 106: 267-

Wang HT, Peng YM, Liu H, et al. Alteration of homocysteine before and after

hemodialysis in chronic hemodialysis patients. Hunan Yi Ke Da Xue Xue Bao

; 28: 266-268.

Parsons DS, Reaveley DA, Pavitt DV, et al. Relationship of renal function to

homocysteine and lipoprotein(a) levels. Am J Kidney Dis 2002; 40: 916-923.

Shoji T, Maekawa K, Emoto M, Okuno S, et al. Arterial stiffness predicts

cardiovascular death independent of arterial thickness in a cohort of

hemodialysis patients. Atherosclerosis 2010; 210: 145-149.

Leoncini G, Francesca V, et al. Mild renal dysfunction and subclinical

cardiovascular damage in primary hypertension. Hypertension 2003; 42: 14-

Lubomirova M, Tzoncheva A, Petrova J, et al. Homocysteine and carotid

atherosclerosis in chronic renal failure. Hippokratia 2007; 11: 205-209

Sydor A, Drozdz M, Krasniak A, et al. Hyperhomocysteinemia and

advancement of atherosclerosis in patients with chronic renal failure on

maintenance hemodialysis. Przegl Lek 2002; 59: 962-967.

Baptista AP, Cacdocar S, Palmeiro H, et al. Inflammation, homocysteine and

carotid intima media thickness. Rev Port Cardiol 2008; 27: 39-48.

Tungkasereerak P, Ongajyooth L, Chaiyasoot W, et al. Effect of short term

folate and vitamin B supplementation on blood homocysteine level and

carotid artery wall thickness in chronic hemodialysis patients. J Med Assoc

Thai 2006; 89: 1187-1193.

Taruangsri P, Ongajyooth L, Ongajyooth S, et al. Relationship between

hyperhomocysteinemia and atherosclerosis in chronic hemodialysis

patients. J Med Assoc Thai 2005; 88: 1373-1381.


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