title: Homocysteine is a risk factor in predialysis patients when associated with malnutrition and inflammation.
abstract: The increased level of plasma total homocysteine (tHcy) in chronic kidney disease patients has been reported as a new and independent risk factor for cardiovascular disease. However, after the description of reverse epidemiology in the renal population, the association of tHcy and nutrition became less clear. We evaluated the association between homocysteine, nutritional status, and inflammation, and their impact on mortality in 95 predialysis patients. High sensitivity C-Reactive Protein (hs-CRP), interleukin 6 (IL-6), Tumor Necrosis Factor α (TNF-α)], and tHcy were evaluated, as was the nutritional status by the modified Subjective Global Nutritional Assessment (mSGA). We divided our population in four groups according to their tHcy and mSGA values being above or below the mean level and found the lowest survival in the group with tHcy and mSGA above the mean level, as well as higher levels of IL-6 (P = .03) and TNF-α (P = .045). Higher levels of homocysteine can be associated with higher mortality in predialysis patients, as long as they are associated with malnutrition and inflammation.
authors.affiliation: Serviço de Nefrologia, Hospital de Faro, Algarve, Rua Leão Penedo, 8000-342 Faro, Portugal.
authors.forename: Ana de Lurdes Agostinho Cabrita
authors.initials: Ade L
authors.lastname: Vieira
authors.forename: Alexandre
authors.initials: A
authors.lastname: Baptista
authors.forename: Anabela
authors.initials: A
authors.lastname: Malho
authors.forename: Ana
authors.initials: A
authors.lastname: Pinho
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Silva
authors.forename: Idalécio
authors.initials: I
authors.lastname: Bernardo
authors.forename: Pedro Leão
authors.initials: PL
authors.lastname: Neves