title: Hyperhomocysteinemia and vascular access thrombosis in hemodialysis patients: a retrospective study.
abstract: BACKGROUND
  Elevated total plasma homocysteine is an independent risk factor for arterial and venous thrombosis in patients with normal renal function. Patients on hemodialysis have a high prevalence of mild to moderate hyperhomocysteinemia. Conflicting retrospective analyses and prospective studies have been reported regarding the association between total homocysteine levels and hemodialysis vascular thrombosis. The purpose of this retrospective study was to investigate the relationship between hyperhomocysteinemia and vascular access thrombosis (VAT) in patients on hemodialysis.
  
  
  METHODS
  One hundred and twenty-five patients undergoing dialysis were selected as subjects. The experimental group participants were identified as those having one or more VAT during the previous 13 months and the control group participants had no access thrombosis during the same period. Additional subgroup analysis included the presence of hypertension, diabetes, low-density lipoprotein levels, sex, and use of aspirin.
  
  
  RESULTS
  No statistically significant difference was found in total homocysteine levels between the two groups (P = 0.27). No association was found between VAT and sex (P = 0.09), VAT and hypertension (P = 0.96), VAT and diabetes (P = 0.49), nor VAT and low-density lipoprotein level (P = 0.04). A lower rate of VAT was associated with aspirin intake (P = 0.04).
  
  
  CONCLUSIONS
  This study did not demonstrate a relationship between total homocysteine concentrations and risk of VAT in patients with end-stage renal disease on hemodialysis. There were no significant differences in the number of VAT across additional variables of sex and previous morbidity. Aspirin intake was associated with a lower incidence of VAT.
authors.affiliation: Staten Island University Hospital, Staten Island, NY 10305, USA. chadisaifan@hotmail.com
authors.forename: Chadi
authors.initials: C
authors.lastname: Saifan
authors.forename: Elie
authors.initials: E
authors.lastname: El-Charabaty
authors.forename: Suzanne
authors.initials: S
authors.lastname: El-Sayegh
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications*; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D006710:Homocysteine; D001241:Aspirin
keywords: hemodialysis; hyperhomocysteinemia; vascular access thrombosis
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