Hyperhomocysteinemia predicts cardiovascular outcomes in hemodialysis patients.
BACKGROUND
We prospectively tested the prediction power of homocysteinemia for all-cause and cardiovascular outcomes in a cohort of 175 hemodialysis patients followed for 29 +/- 12 months.


METHODS
Survival analysis was performed by the Cox's proportional hazard model and data were expressed as hazard ratio and 95% confidence interval (CI).


RESULTS
During the follow-up period 51 patients died, 31 of them (61%) of cardiovascular causes and 16 patients developed non-fatal atherothrombotic complications. Plasma total homocysteine was an independent predictor of cardiovascular mortality (P=0.01). Combined analysis of fatal and non-fatal atherothrombotic events showed that homocysteine was a strong and independent predictor of these outcomes because the risk of these events was 8.2 times higher (95% CI 1.9 to 32.2) in patients in the third homocysteine tertile than in those in the first tertile (P=0.005).


CONCLUSIONS
There is a clear association between hyperhomocysteinemia and incident cardiovascular mortality and atherothrombotic events in hemodialysis patients. Intervention studies are needed to determine whether the accumulation of this substance has a causal role in the pathogenesis of cardiovascular damage in patients undergoing hemodialysis.
Mallamaci
Francesca
F
CNR Centro Fisiologia Clinica e Divisione di Nefrologia, Ospedali Riuniti, Reggio Calabria, Italy.
Zoccali
Carmine
C
Tripepi
Giovanni
G
Fermo
Isabella
I
Benedetto
Francesco A
FA
Cataliotti
Alessandro
A
Bellanuova
Ignazio
I
Malatino
Lorenzo Salvatore
LS
Soldarini
Armando
A
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors
D006710:Homocysteine