Hyperhomocysteinemia and traditional cardiovascular disease risk factors in end-stage renal disease patients on dialysis: a case-control study

Andrew G. Bostom, Douglas Shemin, Kate L. Lapane, Joshua W. Miller, Patrice Sutherland, Marie Nadeau, Elias Seyoum, Wilburta Hartman, Ronald Prior, Peter W F Wilson, Jacob Selhub

Research output: Contribution to journalArticle

188 Scopus citations

Abstract

Hyperhomocysteinemia occurs frequently in end-stage renal disease (ESRD), but its prevalence in comparison with traditional cardiovascular disease (CVD) risk factors is unknown. Fasting total plasma homocysteine, potential determinants of plasma homocysteine (i.e., plasma B-vitamins and serine), total and HDL cholesterol, glucose, and creatinine, were determined in 24 ESRD patients on dialysis, and 24 age, gender, and race matched Framingham Offspring Study controls with normal renal function. Presence of clinical CVD and CVD risk factors was established by standardized methods. Mean plasma homocysteine was markedly higher in the ESRD patients versus controls (22.7 vs. 9.5 μmol/l). ESRD patients were 33 times more likely than controls to have hyperhomocysteinemia (> 15.8 μmol/l) (95% confidence interval, 5.7-189,6). Hyperhomocysteinemia persisted in the ESRD patients despite normal to supernormal B-vitamin status. Plasma serine levels below the tenth percentile of the control distribution were found in 75% of the ESRD patients. Oral serine supplementation caused a 37% increase in mean plasma serine, but had no effect on plasma homocysteine in four ESRD patients with supernormal plasma folate, low plasma serine, and hyperhomocysteinemia. Given its unusually high prevalence, improved management of hyperhomocysteinemia might reduce CVD sequelae in ESRD.

Original languageEnglish (US)
Pages (from-to)93-103
Number of pages11
JournalAtherosclerosis
Volume114
Issue number1
DOIs
StatePublished - Apr 7 1995
Externally publishedYes

Keywords

  • Atherothrombosis
  • Creatinine
  • Homocysteine
  • Renal function
  • Risk factors
  • Serine
  • Vitamins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Bostom, A. G., Shemin, D., Lapane, K. L., Miller, J. W., Sutherland, P., Nadeau, M., Seyoum, E., Hartman, W., Prior, R., Wilson, P. W. F., & Selhub, J. (1995). Hyperhomocysteinemia and traditional cardiovascular disease risk factors in end-stage renal disease patients on dialysis: a case-control study. Atherosclerosis, 114(1), 93-103. https://doi.org/10.1016/0021-9150(94)05470-4