EVALUATION OF PLASMA HOMOCYSTEINE IN KIDNEY TRANSPLANT CANDIDATES WITH DIFFERENT RISKS FOR ACUTE CORONARY EVENTS

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). ‎