Abstract

PARRAGA DIAZ, Mateo; MELERO RUBIO, Esperanza  and  GOMEZ SANCHEZ, María Paz. A prospective study of five years about homocysteinemia levels and cardiovascular risk in patients in a hemodialysis unit. Enferm Nefrol [online]. 2014, vol.17, n.4, pp.277-282. ISSN 2255-3517.  https://dx.doi.org/10.4321/S2254-28842014000400006.

Cardiovascular disease is complex and multifactorial. One of the markers known as independent vascular risk factor is homocysteine. In relation to vascular risk, the increase of 5 mmol / l above the normal range, corresponds to an increase of 20 mg / dl above normal cholesterol. In the general population, slightly elevated homocysteine levels (> 15µmol / l), are associated with increased mortality and cardiovascular events. Also, this factor is present in renal patients, at 3-times higher levels than the general population. Mechanisms by which homocysteine is elevated in renal failure are unclear, since renal excretion represents only 1% of its elimination. However, it has been shown that the use daily of membranes of high flux dialysis, slow nocturnal home dialysis, or on-line hemodiafiltration, significantly reduce these amino acid levels. These treatments could achieve a greater reduction in homocysteine levels and reduce the cardiovascular renal morbid-mortality, therefore, it is advisable to measure homocysteine levels in renal patients annually. The aim was to study the vascular risk in our renal patients in a study of five years, according to the homocysteine levels and determine their relationship with modality and time of treatment, age, sex and ethnicity. A prospective observational study of five year was carried out in our dialysis unit. Data about age, sex, ethnicity, type of treatment (hemodiafiltration versus hemodialysis), duration of treatment and homocysteine levels were collected. 115 patients (68 men and 47 women) with a mean age of 59 years were studied. 107 patients were Mediterranean Caucasians, 4 North African Caucasian and 4 African blacks. 54.8% had less than four years in renal treatment. 63% were on hemodialysis, 27% patients were in alternating hemodiafiltration, and 10% in daily hemodialysis. The mean level of homocysteine in males was 23.47 mmol/l, and in women of 24.29 mmol/l. According to the cultural group, homocysteine levels in the third and fourth year of study, were significant in African black patients, with levels of 51.50 and 69.35 mol/l respectively. In the general population, cardiovascular risk is associated with age and sex. However, homocysteine levels versus these variables in our renal study population are not modified. Other differences are marked by ethnic group: lower in blacks and Asians than in Caucasians, while Latin American had intermediate concentrations. This information do not coincide with our findings, because the Caucasian Mediterranean group (most of our patients) had intermediate values at moderate risk and the African black group had higher values, even of the high risk. We conclude that our patients had a moderate level of vascular risk. When relating homocysteine with sex, age, mode and time of replacement therapy no statistical significant relationship was found. However, ethnicity if present significant variations being the African black the group with higher vascular risk with higher levels in the last three years of the study.

Keywords : homocysteine; dialysis process; cardiovascular risk.

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