Hyperhomocysteinemia and Peripheral Arterial Disease in Patients Undergoing Hemodialysis
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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.
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.
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.
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 wordsHemodialysis homocysteine peripheral arterial disease plethysmography
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