Korean Journal of Nephrology 2001;20(4):663-674.

논평 : 만성 신부전 환자에서 고호모시스틴혈증에 관한 연구 (Editorial : Hyperhomocysteinemia in Patients with Chronic Renal Failure)

박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki Chul Choi)

Abstract

Objective : It has been reported that hyperhomocysteinemia is an independent risk factor for atherosclerotic complications, although the mechanisms re- main unclear. The major determinents of total fasting plasma homocysteine(tHcy) concentrations have been recently reported but there are still conflicting data on the influence of those in peritoneal and hemodialysis patients. Therefore, we evaluated the prevalence and association of vascular complications and the determinents of hyperhomocysteinemia in chronic renal failure patients receiving conservative treatment(predialysis), peritoneal dialysis(PD) and hemodia-lysis (HD) patients. Methods We measured the factors, including fasting plasma vitamine levels(folate, vitamin E4 and vitamin B12), serum creatinine concentration, dialysis adequacy-related varibles as well as associated risk factors for vascular diseases that might affect tHcy concentrations in 37 predilysis, 30 PD, 34 HD patients and 21 normal persons. Continuous variables were compared using independent sample t-test. Spearman's correlation was used to determine the strength of association between tHcy and other predictive varia41es. Percentages were compared using Pearson's chi-square test or Fisher's exact test, depending on the frequencies. Independent determinents of tHcy concentration and atherosclerotic vascular complications were identified using multiple regression analysis. Results : The prevalence of hyperhomocysteinemia was 83.8, 72, 88% among predialysis, PD and HD patients, respectively(Odds ratio was 103.33, 81.43, 150.0 vs. controls, respectively). tHcy values in pre- dialysis, PD and HD patients are significantly higher than those in controls(24.68±9.01, 21.04±8.82, 23.62± 9.46 vs. 8.80±2.07 ㎛oL/L, repectively, p<0.01). Pre- dialysis, PD and HD patients with atherosclerotic vascular complications had higher tHcy concentrations than did predialysis, PD and HD patients with- out vascular complications(21.93±8.71 vs. 32.09±4.71 ㎛oL/L, p<0.01, 17.57±5.85 vs. 28.74±9.70 ㎛oL/L, p<0.01, 19.00±4.29 vs. 33.28±10.13, p<0.01 respectively). We also observed increasing odds ratios of vascular events with increasing tHcy concentrations. For predialysis, PD and HD patients, fasting plasma folate level had negative correlation with tHcy concentrations by spearman's simple correlaltion. And using muliple regression analysis, we recognized hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients. Conclusions: Hyperhomocysteinemia in predialysis, PD and HD patients was more prevalent than that in norrnal controls. Risk of atherosclerotic vascular complications increased with increasing tHcy concentrations. Hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients.