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Hellenic Journal of Surgery

, Volume 90, Issue 5, pp 242–245 | Cite as

Hyperhomocysteinemia and Peripheral Arterial Disease in Patients Undergoing Hemodialysis

  • Katseni K KonstantinaEmail author
  • K Katsenis
Original Article
  • 3 Downloads

Abstract

A high incidence of cardiovascular disease (CVD) and stroke is observed in patients with chronic renal failure (CRF). Moderate hyperhomocysteinemia and endothelial dysfunction are consistent findings in uremic patients, due to generation of oxygen species and decrease in nitric oxide (NO) bioavailability. This study compared groups of patients with different duration of hemodialysis, with a view to determining the association of clinical presentation of peripheral arterial disease (PAD) with age and duration of hemodialysis.

Material-Method

Study was made of 150 adult patients with CRF undergoing dialysis. Regardless of medication, the inclusion criteria were: blood pressure < 150/100 mmHg, low density lipoprotein (LDL) <120 mg/dl, triglycerides (TRG) < 180 mg/dl, glycated hemoglobin (HbA1c) <7.5%. The patients were separated into three groups of 50, according to the duration of hemodialysis; group A < 5 years, group B > 5 years, but < 10 years and group C > 10 years. We evaluated the plasma levels of homocysteine (Hcy), traditional risk factors for arterial disease, the Fontaine stage of PAD and plethysmography, with and without reactive hyperemia, in all of the study patients.

Results

The mean age of the study patients was 63.2 ± 9.5 years, and 52% were men. Although the classic risk factors were similar in all groups, the percentages of patients with raised Hcy levels were higher in groups B and C than in group A.

Not only the incidence but also the severity of PAD was higher in groups B and C than in group A. The number of patients that did not have symptoms of PAD but had abnormal plethysmography was 24/30 for group A, 15/18 for group B and 12/12 for group C, but the difference between groupswas not significant.

Conclusion

Hyperomocysteinemia is an independent risk factor for atherosclerosis in patients undergoing hemodialysis. Its clinical presentation is disturbance of the microcirculation early after the onset of hemodialysis, even in younger patients.

Key words

Hemodialysis homocysteine peripheral arterial disease plethysmography 

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References

  1. 1.
    Rattanasompattikul M, Chanchairujira K, On-Ajyooth L, et al. Evaluation of atherosclerosis, arterial stiffness and related risk factors in chronic hemodialysis patients in Siriraj Hospital. J Med Assoc Thai 2011;94 Suppl 1:S117–24.Google Scholar
  2. 2.
    Long Y, Nie J. Homocysteine in renal injury. Kidney Dis (Basel). 2016;2:80–7.CrossRefGoogle Scholar
  3. 3.
    Catena C, Colussi G, Nait F, et al. Elevated homocysteine levels are associated with the metabolic syndrome and cardiovascular events in hypertensive patients. Am J Hypertens 2015;28:943–50.CrossRefGoogle Scholar
  4. 4.
    Sagheb MM, Ostovan MA, Sohrabi Z, et al. Hyperhomocysteinemia and cardiovascular risks in hemodialysis patients. Kidney Dis Transpl 2010;21:863–6.Google Scholar
  5. 5.
    Ueland PM, Refsum H. Plasma homocysteine, a risk factor for vascular disease: Plasma levels in health, disease and drug therapy. J Lab Clin Med 1989;114:473–501.Google Scholar
  6. 6.
    Robinson K, Gupta A, Dennis V, et al. Hyperhomocysteinemia confers as independent increase risk of athrosclerosis in endstage renal disease and is closely linked to plasma folate and and pyridoxine cocentrations. Circulation 1996;94:2743–8.CrossRefGoogle Scholar
  7. 7.
    Blundell G, Jones BG, Rose FA, et al. Homocysteine-mediated endothelial cell toxicity and its ameloration. Atherosclerosis 1996;122:163–72.CrossRefGoogle Scholar
  8. 8.
    Tawakol A, Omland T, Gerhhard M, et al. Hyperhomocysteinemia is associated with impaired endothelium-dependent vasodilation in humans. Circulation 1997;95:1119–21.CrossRefGoogle Scholar
  9. 9.
    Sreckovic B, Sreckovic VD, Soldatovic I, et al. Homocysteine is a marker for metabolic syndrome and atherosclerosis Diabetes Metab Syndr 2017;11:179–82.CrossRefGoogle Scholar
  10. 10.
    Jourde-Chiche N, Dou L, Cerini C, et al. Vascular incompetence in dialysis patients—protein-bound uremic toxins and endothelial dysfunction. Semin Dial 2011;24:327–37.CrossRefGoogle Scholar
  11. 11.
    Joannidis R, Bakkali EH, Le Roy F, et al. Altered flowdependent vasodilation of conduit arteries in maintenance heamodialysis. Nephrol Dial Transplant 1997;12:2623–8.CrossRefGoogle Scholar
  12. 12.
    Van Guldener C, Lambert J, Janssen MJFM, et al. Endothelium-dependent vasodilation and distensbility of large arteries in chronic heamodialysis patients. Nephrol Dial Trasplant 1997;12:S14–8.Google Scholar
  13. 13.
    Jacobsen DW, Gatautis VJ, Green R. Determination of plasma homocysteine by high-performance liquid chromatography with fluorescence detection. Analytical Biochemistry 1989;178:208–14.CrossRefGoogle Scholar
  14. 14.
    Xie D, Yuan Y, Guo J, et al. Hyperhomocysteinemia predicts renal function decline: A prospective study in hypertensive adults. Sci Rep 2015;5:16268.CrossRefGoogle Scholar
  15. 15.
    Hultberg B, Andersson A, Arnadottir M. Reduced free and total fractions of homocystinemia and other thiol compounds in plasma from patients with renal failure. Nephron 1995;70:62–7.CrossRefGoogle Scholar
  16. 16.
    Babaei M, Dashti N, Lamei N, et al. Evaluation of plasma concentrations of homocysteine, IL-6, TNF-alpha, hs-CRP, and total antioxidant capacity in patients with end-stage renal failure. Acta Med Iran 2014;52:893–8.Google Scholar
  17. 17.
    Abais JM, Xia M, Li G, et al. Contribution of endogenously produced reactive oxygen species to the activation of podocyte NLRP3 inflammasomes in hyperhomocysteinemia. Free Radic Bio Med 2014;67:211–20.CrossRefGoogle Scholar
  18. 18.
    Toda N, Okamura T. Hyperhomocysteinemia impairs regional blood flow: Involvements of endothelial and neuronal nitric oxide. Pflugers Arch 2016;468:1517–25.CrossRefGoogle Scholar
  19. 19.
    Lentz SR. Homocysteine and vascular dysfunction. Life Sci 1997;61:1205–15.CrossRefGoogle Scholar
  20. 20.
    Heinecke JW, Kawmura M, Suzuki L, et al. Oxidation of low desity lipoprotein by thiols: Superoxide-dependent and independent mechanisms. J Lipid Res 1993;34:2051–61.Google Scholar
  21. 21.
    Perna AF, Luciano MG, Pulzella P, et al. Is homocysteine toxic in uremia? J Ren Nutr 2008;18:12–7.CrossRefGoogle Scholar

Copyright information

© Hellenic Surgical Society and Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Medical School, 2nd Surgical Department, Vascular Surgery UnitNational and Kapodistrian University of AthensAthensGreece

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