PMID- 10760109
OWN - NLM
STAT- MEDLINE
DCOM- 20000509
LR  - 20131121
IS  - 0085-2538 (Print)
IS  - 0085-2538 (Linking)
VI  - 57
IP  - 4
DP  - 2000 Apr
TI  - Hyperhomocysteinemia, nutritional status, and cardiovascular disease in 
      hemodialysis patients.
PG  - 1727-35
AB  - BACKGROUND: Hyperhomocysteinemia, cardiovascular disease (CVD), and malnutrition 
      are common in patients with end-stage renal disease (ESRD). This study was 
      designed to assess possible relationships between total plasma homocysteine 
      (tHcy), nutritional status, and ischemic CVD. METHODS: We performed a 
      cross-sectional study in 117 unselected patients on maintenance hemodialysis (HD) 
      treatment, among whom there was a high prevalence of malnutrition (56%), as 
      assessed by the subjective global nutritional assessment (SGNA), and a high 
      prevalence of CVD (60%), and prospectively, we followed-up the overall mortality 
      for four years. RESULTS: The level of tHcy was elevated in 95% of the HD 
      patients, and that of total plasma cysteine (tCys) was also significantly 
      elevated, while the plasma concentrations of methionine (Met), serine (Ser), and 
      taurine (Tau) were significantly lower than those in healthy controls. The 65 
      patients who were malnourished according to the SGNA score had significantly 
      lower levels of serum albumin (SAlb), plasma IFG-1 (p-IGF-1), tHcy, tCys, and Met 
      than the 52 patients with normal nutritional status, whereas the levels of Ser, 
      Tau, plasma folate, and vitamin B12 were similar in the two groups. The 
      prevalence of malnutrition was 30% in the 47 patients without CVD and was 
      significantly higher (70%, P < 0.001) in the 70 patients with CVD, who also had 
      lower tHcy, SAlb, plasma IGF-1, serum creatinine (SCr), and blood hemoglobin. The 
      tHcy levels were positively correlated with SAlb, Met, tCys, and SCr. Stepwise, 
      multiple-regression analysis showed that tCys, SAlb, and normalized protein 
      equivalent of nitrogen appearance (nPNA), an indicator of protein intake, were 
      independent predictors of tHcy. The patients with tHcy <24 micromol/L (median 
      value) had a significantly worse four-year survival than those with a higher tHcy 
      (> or =24 micromol/L). CONCLUSIONS: Our results demonstrate that most of HD 
      patients have grossly elevated tHcy levels, but that the absolute level appears 
      to be dependent on nutritional status, protein intake, and SAlb. The results also 
      suggest that the lower tHcy levels in patients with CVD than in those without CVD 
      may be related to the higher prevalence of malnutrition and hypoalbuminemia in 
      the CVD patients. This is also in accordance with our observation that the 
      patients with lower tHcy had a worse survival rate than those with higher tHcy, 
      considering that malnutrition is a strong risk factor for mortality and that CVD 
      is the most common cause of death in ESRD patients.
FAU - Suliman, M E
AU  - Suliman ME
AD  - Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, 
      Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
FAU - Qureshi, A R
AU  - Qureshi AR
FAU - Barany, P
AU  - Barany P
FAU - Stenvinkel, P
AU  - Stenvinkel P
FAU - Filho, J C
AU  - Filho JC
FAU - Anderstam, B
AU  - Anderstam B
FAU - Heimburger, O
AU  - Heimburger O
FAU - Lindholm, B
AU  - Lindholm B
FAU - Bergstrom, J
AU  - Bergstrom J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
RN  - 0 (Amino Acids)
RN  - 0 (Dietary Proteins)
RN  - 0 (Serum Albumin)
RN  - K848JZ4886 (Cysteine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Amino Acids/blood
MH  - Cardiovascular Diseases/*complications/physiopathology
MH  - Cross-Sectional Studies
MH  - Cysteine/blood
MH  - Dietary Proteins/administration & dosage
MH  - Female
MH  - Humans
MH  - Hyperhomocysteinemia/*complications
MH  - Kidney Failure, Chronic/complications/mortality/physiopathology/therapy
MH  - Male
MH  - Middle Aged
MH  - Nutrition Disorders/complications
MH  - *Nutritional Status
MH  - Prospective Studies
MH  - *Renal Dialysis
MH  - Serum Albumin/analysis
MH  - Survival Analysis
EDAT- 2000/04/12 09:00
MHDA- 2000/05/16 09:00
CRDT- 2000/04/12 09:00
PHST- 2000/04/12 09:00 [pubmed]
PHST- 2000/05/16 09:00 [medline]
PHST- 2000/04/12 09:00 [entrez]
AID - S0085-2538(15)46923-6 [pii]
AID - 10.1046/j.1523-1755.2000.00018.x [doi]
PST - ppublish
SO  - Kidney Int. 2000 Apr;57(4):1727-35. doi: 10.1046/j.1523-1755.2000.00018.x.