title: Hyperhomocysteinemia is a significant risk factor for silent cerebral infarction in patients with chronic renal failure undergoing hemodialysis.
abstract: In patients with chronic renal failure undergoing hemodialysis (HD), the presence of silent cerebral infarction (SCI) is associated with high mortality. Plasma total homocysteine (tHcy), which increases with renal dysfunction, has been flagged as a novel predictor for cerebrovascular events. We tested the hypothesis that the presence of SCI correlates with tHcy in HD patients. Based on brain magnetic resonance imaging findings, 44 patients undergoing HD were divided into a with-SCI group (61+/-9 years [mean+/-SD]; n=24) and a without-SCI group (60+/-8 years, n=20), in whom 24-hour ambulatory blood pressure monitoring was performed. The number of patients with diabetes or hypertension was not different between the 2 groups. We made the following observations: (1) the percentage of smokers was higher in the with-SCI group than in the without-SCI group (P<.05); (2) plasma levels of high-density lipoprotein cholesterol were lower and tHcy was higher in the with-SCI group than in the without-SCI group (P<.05 and P<.0001, respectively); (3) and systolic ambulatory blood pressure and mean heart rate during nighttime were higher in the with-SCI group than in the without-SCI group (P<.05). Multivariate logistic analysis identified hyperhomocysteinemia as an independent and significant risk factor for SCI (odds ratio, 1.22; 95% CI, 1.10-1.36; P<.01). Our findings indicate that plasma tHcy may be a novel useful predictor for SCI in patients with chronic renal failure undergoing HD.
authors.affiliation: Department of Cardiology, Oita Red Cross Hospital, and Department of Cardiovascular Science, School of Medicine, Oita University, Oita 879-5593, Japan. anan-f@med.oita-u.ac.jp
authors.forename: Futoshi
authors.initials: F
authors.lastname: Anan
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shimomura
authors.forename: Muneharu
authors.initials: M
authors.lastname: Imagawa
authors.forename: Kunio
authors.initials: K
authors.lastname: Yufu
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nawata
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Yonemochi
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Eshima
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
authors.forename: Hironobu
authors.initials: H
authors.lastname: Yoshimatsu
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory; D002544:Cerebral Infarction / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D012907:Smoking
chemical_list: D008076:Cholesterol, HDL