Mashhad , Iran
Objective- Acute coronary events are the major cause of death among patients with ESRD and kidney transplant candidates. It has been determined that the plasma homocysteine level is high in these patients. In addition, a large series of cross-sectional and retrospective studies indicate a positive relationship between mild and moderate hyperhomocysteinemia and atherosclerosis.
Background- classification of patients with ESRD into high risk and low-risk groups for coronary events, based on defined clinical and laboratory criteria, is mandatory before kidney transplantation. In respect to this classification, important diagnostic and therapeutic approaches are planned to decrease the risk of coronary events during kidney transplantation. The plasma homocysteine level has not yet been compared between these two groups.
Method- In this cross-sectional study, 92 patients were enrolled and classified into low and high-risk groups of coronary events and their homocysteine level was measured. Inclusion criteria for this classification were age, hypertension, hyperlipidemia, diabetes, smoking, ischemia in surface ECG, and clinical findings of ischemic heart disease. Results- The average level of plasma homocysteine wasl4.98±7.8µmol/L among all of the patients, 17.28±8.5 µ mol/L in the high risk group and 11.46±3.7µmol/L in the low risk group. There was no significant correlation between the plasma homocysteine level and other known risk factors (P=0.564, rs=0.0697). In addition, there was no significant difference in dialysis type, serum creatinine level, dialysis duration and adequacy of dialysis between the two groups. However, there was a significant difference between the plasma homocysteine level in the high risk and low risk groups (P=0.0003, V=3.585).
Conclusion- The plasma homocysteine level has a significant correlation with the risk of coronary events in end-stage renal disease (ESRD) patients. It seems that the plasma homocysteine level, like other known ischemic heart disease risk factors, is a predictor of coronary events before kidney transplantation (Iranian Heart Journal 2002, 2003; 3(4) & 4(1): 65-69).