The factors that affect plasma homocysteine levels, pulse wave velocity and their relationship with cardiovascular disease indicators in peritoneal dialysis patients

Abstract

The incidence of cardiovascular diseases (CVD) is high in end-stage renal disease (ESRD) population and hyperhomocysteinemia is an important CVD risk factor. The aims of this study are to asses the incidence of hyperhomocysteinemia and the factors that affect the homocysteine (Hcy) levels in peritoneal dialysis (PD) patients, and to analyze the relationships between Hcy levels and clinical and echocardiographic CVD, and the pulse wave velocity (PWV). Sixty ESRD patients undergoing PD for at least 6 months were included in the study. Biochemical parameters, echocardiography, and PWV were analysed for every subject. Mean Hcy level was 27.2 +/- 15.7 micromol/L and was high in 53 patients (88.3%). Fibrinogen, dialysate/plasma creatinine ratio and folic acid were found to be the independent predictors of Hcy level (P < 0.001; P < 0.01; P < 0.05, respectively). Patients with atherosclerosis had significantly higher plasma Hcy levels (P < 0.05). No significant relationship was found between plasma Hcy levels and echocardiographic findings and PWV. Hyperhomocysteinemia incidence seems high among PD patients and despite significant relationship between fibrinogen and Hcy in our study, it is essential to evaluate the link between Hcy levels and inflammation. Folic acid replacement even in normal folic acid levels, enough elimination of volume and solutes may be beneficial to control Hcy levels, whereas PWV was found to be related with comorbidities and and dialysate kinetics.