Hyperhomocysteinemia, a Risk Factor for Arteriovenous Fistula Thrombosis in Hemodialysis Patients

Abstract

1.1.Purpose:Homocysteine, a putative risk factor of cardiovascular disease is considerably high in hemodialysis patients. The aim of this study was to identify the association between homocysteine level and occurrence of fistula thrombosis in newly developed hemodialytic patients with arteriovenous (AV) fistula. 1.2.Method:In this prospective study 120 patients with ESRD who were candidate for AV fistula insertion, were enrolled. The association between homocysteine level, age, sex, and underlying disease leaded to ESRD and incidence of AV fistula thrombosis was analyzed by means of Logistic Regression model. 1.3. Result: Of 120 patients (69 men, 51 women), the mean age was 57.64±1.54 years. The mean serum tHcy value was 30.85±12.37 µmol. Hyperhomocysteinemia was presented in 106 patients (88.3%). During 6 month of follow up, 14 patients (11.7%) (9 men, 5 women) experienced fistula thrombosis. Logistic regression analysis demonstrated that tHcy level was significantly higher in patients with incident fistula thrombosis compared with patients without this event (41.61±11.53 vs. 29.43±11.94) (p<0.007). Homocysteine cutoff point was determined at 25 µmol/L (sensitivity 100% and specificity 36.6%). Regarding to Logistic Regression model, each 10 µmol/L increases in plasma tHcy level will increase the risk of fistula thrombosis by 10.8% ( 95% CI, 10 to 12%) (Exp (B) (OR) =1.85). 1.4.Conclusion: According to high incidence of VA thrombosis and Hyperhomocysteinemia in hemodialysis patients and strong association between thrombosis and Hyperhomocysteinemia, interventional studies are needed to show the effect of lowering homocysteine level before insertion of fistula on thrombotic events in this population.