Assessing Plasma Total Homocysteine in Patients with End-Stage Renal Disease

Urquhart, Bradley L.; House, Andrew A.

doi:10.1177/089686080702700502

Cited by 14 publications

(6 citation statements)

References 108 publications

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“…Induction of oxidative stress and the promotion of in ammation and thrombosis are mechanisms by which the increased Hcy may be involved in advanced athero-sclerosis [35]. Our results indicated that dialysis can remove Hcy, similar to the results reported in a review article by Urquhart et al [17].…”

Section: Discussionsupporting

confidence: 90%

“…ese homocysteinylated proteins could induce autoimmune responses and play a role in pathogenesis of atherosclerosis [16]. Several studies have shown that there are elevated Hcy levels in patients with ESRD [17]; however, there is no the proven evidence for increased Hcy in renal disease. Perhaps, performing of the direct experiments on homocysteinemetabolizing enzymes could be helpful in revealing the cause of hyperhomocysteinemia in renal disease [17].…”

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confidence: 99%

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Increased oxidized-LDL levels and arylesterase activity/HDL ratio in ESRD patients treated with hemodialysis

Mahrooz¹,

Zargari²,

Sedighi³

et al. 2012

CIM

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Purpose: Investigations, in which oxidized-low density lipoprotein (ox-LDL), serum paraoxonase (PON1) and homocysteine (Hcy) are considered together as important agents involved in the development of oxidative and atherogenic events in non-diabetic hemodialysis (HD) population, are limited. This case-control study was designed to evaluate these parameters in the patients and control subjects and to determine the correlations among the factors. Methods: Forty-nine age- and sex- matched subjects, including 28 non-diabetic HD patients (paired pre-and post-dialysis samples) and 21 control subjects, were enrolled. Ox-LDL and Hcy levels were measured with ELISA and EIA methods, respectively. Arylesterase activity of PON1 was measured by spectrophotometric assay. Results: Compared with the control group, ox-LDL levels were significantly increased both before (p=0.001) and after HD (p=0.036). Arylesterase activity-to-HDL ratio in HD patients was significantly higher than control subjects (p=0.003). Homocysteine levels in the ESRD patients were higher than control subjects both in pre-dialysis and post-dialysis. There was a significant positive correlation (r= 0.25, p= 0.026) between ox-LDL and homocysteine in samples obtained before HD. Logistic regression analysis revealed ox-LDL levels (OR=3.02, p < 0.001) and arylesterase activity/HDL ratio (OR=2.43, p=0.01) to be associated with the increased risk of ESRD. Conclusions: Ox-LDL levels and arylesterase activity/HDL ratio indicated the strongest association with ESRD risk. These factors, especially ox-LDL as an indicator of oxidative stress, may be biomarkers in evaluating the status of non-diabetic ESRD patients. Because of the pathogenic relationship between ox-LDL and homocysteine as nontraditional risk factors of atherosclerosis, therapeutic strategies adopted to reduce them may be useful in decrease of high prevalence of cardiovascular mortality in dialysis patients. In addition, measurement of PON1 activity to HDL ratio is possibly a more valuable biomarker than arylesterase activity alone in non-diabetic ESRD.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Increased oxidized-LDL levels and arylesterase activity/HDL ratio in ESRD patients treated with hemodialysis

Mahrooz¹,

Zargari²,

Sedighi³

et al. 2012

CIM

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“…Indeed more than 90% of patients with advanced CKD have hyperhomocysteinaemia. Prospective observational studies show a greater risk of coronary artery disease in the presence of elevated homocysteine levels (161) and it is an independent risk factor for the development of cardiovascular disease (162). Mechanisms include inducing dysfunction of the vascular endothelium, (163) increasing proliferation of VSMC (164) and increasing oxidative stress (165).…”

Section: Homocysteine and Hyperuricaemiamentioning

confidence: 99%

Risk factors and metabolic mechanisms in the pathogenesis of uraemic cardiac disease

Bhandari¹

2011

Front Biosci

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Chronic kidney disease has been increasingly recognized as a risk factor for incident heart failure. Despite advances in chronic heart failure treatment, the prognosis remains poor. The annual mortality from all cardiovascular causes in the end stage renal disease population is significantly higher than the general population, accounting for more than half of all deaths in this group. The mechanisms underlying the enhanced susceptibility to myocardial ischemia in chronic kidney disease are not well defined. Traditional cardiovascular risk factors, although common in chronic kidney disease, do not exert the same impact as in the general population. The presence of "renal-specific" non-traditional risk factors including endothelial dysfunction, inflammation, oxidative stress, anaemia, proteinuria and changes in vitamin D metabolism (encompassing the complex interactions of calcium and phosphate metabolism, hyperparathyroidism and vascular calcification) play an important role in cardiovascular disease progression. An increased understanding of the array of metabolic changes/adaptations occurring in uraemic heart disease have allowed one to consider optimal management strategies and to develop new strategies for future management of uraemic heart disease.

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“…Elevated homocysteine has been associated with worsening cardiovascular outcomes in a number of observational studies [ 54 ], and has been a target of study in CKD. However, vitamin therapy to lower homocysteine has been unhelpful in patients with advanced CKD [ 55 , 56 ] and harmful in patients with diabetes and more moderate CKD [ 57 ].…”

Section: Management Of Chronic Reno-cardiac Syndrome (Type 4)mentioning

confidence: 99%

Pharmacological Management of Cardiorenal Syndromes

House

Haapio

Lassus

et al. 2011

International Journal of Nephrology

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Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pharmacological management of Cardiorenal syndromes may be complicated by unanticipated or unintended effects of agents targeting one organ on the other. Hence, a thorough understanding of the pathophysiology of these disorders is paramount. The treatment of cardiovascular diseases and risk factors may affect renal function and modify the progression of renal injury. Likewise, management of renal disease and associated complications can influence heart function or influence cardiovascular risk. In this paper, an overview of pharmacological management of acute and chronic Cardiorenal Syndromes is presented, and the need for high-quality future studies in this field is highlighted.

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Assessing Plasma Total Homocysteine in Patients with End-Stage Renal Disease

Cited by 14 publications

References 108 publications

Increased oxidized-LDL levels and arylesterase activity/HDL ratio in ESRD patients treated with hemodialysis

Increased oxidized-LDL levels and arylesterase activity/HDL ratio in ESRD patients treated with hemodialysis

Risk factors and metabolic mechanisms in the pathogenesis of uraemic cardiac disease

Pharmacological Management of Cardiorenal Syndromes

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