title: What is the meaning of homocysteine in patients on dialysis?
abstract: OBJECTIVE
  To evaluate the determinants of total plasma homocysteine levels and their relations with nutritional parameters, inflammatory status, and traditional risk factors for cardiovascular disease in renal failure patients on dialysis treatment.
  
  
  METHODS
  The study was conducted on 70 clinically stable patients, 50 of them on hemodialysis (70% men; 55.3 ± 14.5 years) and 20 on peritoneal dialysis (50% men; 62 ± 13.7 years). Patients were analyzed in terms of biochemical parameters (serum lipids, creatinine, homocysteine [Hcy], creatine-kinase [Ck], folic acid, and vitamin B(12)), anthropometric data, markers of inflammatory status (tumor necrosis factor-alpha, C-reactive protein, interleukin-6), and adapted subjective global assessment.
  
  
  RESULTS
  The total prevalence of hyperhomocysteinemia (>15 μmol/L) was 85.7%. Plasma folic acid and plasma vitamin B(12) were within the normal range. Multiple regression analysis (r(2) = 0.20) revealed that the determinants of total Hcy were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Hcy was positively correlated with albumin and creatinine and negatively correlated with total cholesterol, high density lipoprotein cholesterol, folic acid, and vitamin B(12).
  
  
  CONCLUSIONS
  The determinants of total Hcy in the study sample were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Evidently, the small sample size might have had an effect on the statistical analyses and further studies are needed. However, Hcy in patients on dialysis treatment may not have the same effect as observed in the general population. In this respect, the association between malnutrition and inflammation may be a confounding factor in the determination of the true relationship between Hcy, nutritional status, and cardiovascular risk factors in this group.
authors: Department of Internal Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors: Carla Cristina
authors: CC
authors: Silva de Almeida
authors: Daiane Cristina
authors: DC
authors: Guerra
authors: Maria Terezinha I
authors: MT
authors: Vannucchi
authors: Tufik J M
authors: TJ
authors: Geleilete
authors: Helio
authors: H
authors: Vannucchi
authors: Paula Garcia
authors: PG
authors: Chiarello
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D002097:C-Reactive Protein / Q000032:analysis; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology* / Q000209:etiology; D007249:Inflammation / Q000150:complications; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D010530:Peritoneal Dialysis; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D008055:Lipids; D014409:Tumor Necrosis Factor-alpha; D006710:Homocysteine; D002097:C-Reactive Protein; D005492:Folic Acid; D003404:Creatinine; D003402:Creatine Kinase; D014805:Vitamin B 12