Clinical Implication of Hyperhomocysteinemia in Hemodialysis Patients: Impact of Nutritional Status

Kim, Su Hyun; Kim, Young Shin; Ryue, Yeun Ju; Ryue, Kum Hei; Kim, Mi Youn; Choi, Gyu Bog; Yoon, Kyun Il; Kang, Duk Hee

Abstract

BACKGROUND
Cardiovascular disease (CVD), especially ischemic heart disease (IHD) and vascular access occlusion (VAO) is the most common morbidity in dialysis patients. Hyperhomocysteinemia (HHcy) is regarded as an independent risk factor of atherosclerosis in general population, however clinical implication of HHcy in dialysis patients is controversial. Nutritional status of dialysis patients is also known to be closely linked to CVD. METHODS: To investigate the impact of the presence of HHcy and malnutrition on cardiovascular events, especially ischemic heart disease (IHD) and vascular access occlusion (VAO). We measured plasma levels of Hcy and other biochemical parameters with an evaluation of nutritional status using subjective global assessment (SGA) in 44 HD patients and gender-matched control subjects of comparable age. RESULTS: Mean plasma Hcy was 18.6 microM/L (range 5-28), which was significantly higher than normal control (8.6+/-2.0 microM/L, p< 0.05). There was no significant correlation between plasma Hcy and the levels of folate or vit B12. Mean Hcy was significantly higher in patients with normal nutritional status compared to mild-to-moderately malnourished patients (22.0+/-3.2 vs. 15.1+/-4.1 microM/L, p<0.05), and there was a significant positive correlation of Hcy level with serum albumin or nPNA. There was no significant difference in plasma Hcy level according to the presence of IHD or VAO. However, interestingly, in HD patients group with lower serum albumin (<3.9 g/ dL), frequency of VAO was significantly correlated with Hcy (r2=0.68, p<0.001) whereas no significant correlation was observed in patients with higher albumin level. CONCLUSION: The clinical implication of HHcy in HD patients may be different from general healthy population. Nutritional status can be one of the important factors influencing plasma Hcy level. And, high plasma level of Hcy in malnourished HD patients has to be carefully followed up in terms of the development of atherosclerotic CVD and VAO.