Homocysteine and vascular access thrombosis in a cohort of end-stage renal disease patients.
BACKGROUND
Maintaining successful hemodialysis services is dependent upon an access to circulation that is reliable and stable. Complications of vascular access such as dysfunction, thrombosis, or infection are major causes of hospitalization with thrombosis being the most common reoccurring problem. Initial prospective evidence supports an independent association between total homocysteine (tHcy) levels and access thrombosis. The purpose of this study was to determine if significant associations exist between tHcy, age, gender, and vascular access thrombosis in patients with end-stage renal disease (ESRD).


METHODS
One hundred eighty-five (N=185) patients undergoing dialysis were selected as subjects. The retrospective sample was divided into a one or less vascular access thrombosis (VAT) (VAT) group (n= 133) and more than one (VAT II) VAT group (n= 52). The data was collected during a 16-month period (January 2000 to April 2002). Additional subgroup analyses included gender and age.


RESULTS
The Mann-Whitney U nonparametric t-Test for variance between groups revealed no significant difference in tHcy values between VAT groups (U=1841.50, p=0.284). A two-sample t-Test for variance between tHcy and age revealed no significant differences (F-ratio = 0.832, p = 0.32). A chi-square analysis revealed no significant differences in gender and VAT groups (chi2=0.246, p=0.62). A Kolmogorov-Smirnov test for normality was calculated for tHcy with a p-value of 0.859 revealing insufficient evidence that the distribution is not normal. Spearman Rank Correlations were calculated, revealing low to moderate associations among variables.


CONCLUSIONS
While some studies have demonstrated a relationship between tHcy and VAT, this study found that chronically high homocysteine levels in patients with ESRD were not associated with incidence of VAT. There were no significant differences in the number of VATs across additional variables of age and gender.
Bowden
Rodney G
RG
Department of Health, Human Performance, and Recreation, Center for Exercise, Nutrition, and Preventive Health Research, Baylor University, Waco, Texas 76798-7313, USA. Rodney_Bowden@baylor.edu
Wyatt
Frank B
FB
Wilson
Ronald
R
Wilborn
Collin
C
Gentile
Mindy
M
D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology
D006710:Homocysteine