title: Persistent homocysteine metabolism abnormality accelerates cardiovascular disease in hemodialyzed patients--the Nishinomiya Study.
abstract: OBJECTIVE
  Homocysteine (Hcy) is an intermediate in sulfur amino acid metabolism and may induce oxidative stress. Several studies have reported that elevated Hcy in end-stage renal failure may contribute to cardiovascular disease (CVD). The purpose of this study is to investigate whether the changes in Hcy levels correlate better with the CVD outcomes than baseline Hcy level.
  
  
  METHODS
  A total of 187 patients on dialysis participated in the present prospective observational study and were followed up for 107 months. Baseline cross-sectional analysis of the relationship between Hcy and several factors related to its metabolism was performed, along with survival analysis for the occurrence of CVD. All subjects were divided into the Increase or Decrease of Hcy group on the basis of changes in Hcy from baseline to year 3.
  
  
  RESULTS
  The occurrence of CVD was higher in the Increase (30.1%) than in the Decrease group (9.0%). Greater change of Hcy was associated with risk of CVD (hazard ratio: 3.658) after adjusting basic factors and nutritional status. In stepwise multiple analyses, serum folate, vitamin B(12), cysteine, creatinine, and body mass index were considered to be independent predictors of Hcy.
  
  
  CONCLUSIONS
  These data show that increase in Hcy is a powerful predictor of the occurrence of CVD in patients on dialysis.
authors.affiliation: Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Hasuike
authors.forename: Yasue
authors.initials: Y
authors.lastname: Hama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Kahori
authors.initials: K
authors.lastname: Hori
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokuyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Toyoda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hazeki
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nanami
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Otaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kuragano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakanishi
mesh_terms: D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D006710:Homocysteine; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12