Hyperhomocysteinemia confers an independent increased risk of atherosclerosis in end-stage renal disease and is closely linked to plasma folate and pyridoxine concentrations

Killian Robinson, Anjan Gupta, Vincent Dennis, Kristopher Arheart, Debashish Chaudhary, Ralph Green, Paul Vigo, Ellen L. Mayer, Jacob Selhub, Michael Kutner, Donald W. Jacobsen

Research output: Contribution to journalArticlepeer-review

335 Scopus citations

Abstract

Background: A high level of total plasma homocysteine is a risk factor for atherosclerosis, which is an important cause of death in renal failure. We evaluated the role of this as a risk factor for a vascular complications of end-stage renal disease. Methods and Results: Total fasting plasma homocysteine and other risk factors were documented in 176 dialysis patients (97 men, 79 women; mean age 56.3±14.8 years). Folate, vitamin B 12, and pyridoxal phosphate concentrations were also determined. The prevalence of high total homocysteine values was determined by comparison with a normal reference population, and the risk of associated vascular complications was estimated by multiple logistic regression. Total homocysteine concentration was higher in patients than in the normal population (26.6±1.5 versus 10.1±1.7 μmol/L; P<.01). Abnormally high concentrations (>95th percentile for control subjects, 16.3 μmol/L) were seen in 149 patients (85%) with end- stage renal disease (P<.001). Patients with a homocysteine concentration in the upper two quintiles (>27.8 μmol/L) had an independent odds ratio of 2.9 (CI, 1.4 to 5.8; P=.007) of vascular complications. B vitamin levels were lower in patients with vascular complications than in those without. Vitamin B 6 deficiency was more frequent in patients than in the normal reference population (18% versus 2%; P<.01). Conclusions: A high total plasma homocysteine concentration is an independent risk factor for atherosclerotic complications of end-stage renal disease. Such patients may benefit from higher doses of B vitamins than those currently recommended.

Original languageEnglish (US)
Pages (from-to)2743-2748
Number of pages6
JournalCirculation
Volume94
Issue number11
StatePublished - 1996
Externally publishedYes

Keywords

  • coronary disease
  • kidney
  • risk factors

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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