Hyperhomocysteinaemia and vascular access thrombosis among chronic hemodialysis patients in Taiwan: a retrospective study

Abstract

Vascular access thrombosis (VAT) is an important cause of morbidity for chronic haemodialysis (HD) patients. Some risk factors for VAT have been well-defined for chronic HD patients from western countries. However, only a few such factors have been confirmed for Taiwanese patients. This study attempted to determine the association between hyperhomocysteinaemia and the incidence of VAT for chronic HD patients in Taiwan. We retrospectively enrolled a total of 196 patients into this study during 2003. The patients were separated into VAT (n = 142) and control (n = 54) group. The participants of the VAT group were identified as those having one or more VAT, and the participants of the control group were those with no VAT in the past. The mean follow-up period was 48 months. The mean serum homocysteine levels were 29.5 +/- 9.6 and 29.1 +/- 9.5 micromol/l for the VAT (n = 142) and the control (n = 54) group, respectively. There was no significant difference in the level of homocysteine between the VAT and the control group (p = 0.70). Female chronic HD patients had significantly greater mean total homocysteine levels than male (30.89 micromol/l, 95% CI 28.84-32.94 vs. 28.06 micromol/l, 95% CI 26.32-29.82, respectively, p = 0.038). That synthetic graft was a significant risk factor for VAT was determined using multivariate logistic regression analysis. There was no association between serum total homocysteine levels and the incidence of VAT in chronic HD patients in Taiwan.

The association between pulse pressure and vascular access thrombosis in chronic hemodialysis patients

“…1 In the traditional view, neointimal hyperplasia and luminal stenosis are the keys to the development of VAT. 1 Mounting evidence has shown that VAT is associated with an increase in systemic inflammation markers, such as C-reactive protein (CRP) 2 and homocysteine, 3,4 in chronic HD patients. An increase in inflammatory markers, such as macrophages, lymphocytes, vascular cell adhesion molecule-1, tumor necrosis factor-a and interleukin-6, is found on primary stenotic lesions.…”

5-Methyltetrahydrofolate Administration Is Associated with Prolonged Survival and Reduced Inflammation in ESRD Patients

“…Paradoxically, two recent studies showed that patients with very low homocysteine plasma levels had worse outcomes including a higher incidence of hospitalization and mortality [7, 8]. This raises the question as to whether elevated homocysteine in uremic patients is consequential rather than causal in the role of cardiovascular complications [9,10,11]. …”

Hyperhomocysteinemia and vascular access thrombosis in hemodialysis patients: a retrospective study

“…Bowden et al showed in both a retrospective study of 114 patients15 and in a prospective study of 185 patients16 that chronically high homocysteine levels in patients with end-stage renal disease were not associated with an increased incidence of VAT. A retrospective Taiwanese study conducted by Chen et al in 196 patients on chronic hemodialysis showed no relationship between homocysteine and VAT 17. Manns et al found no association between homocysteine levels or anticardiolipin antibody and VAT in a cross-sectional study involving 118 patients 3.…”