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Hyperhomocysteinemia is accepted as an independent risk factor in the progression of atherosclerosis. This relationship is valid in end stage renal disease (ESRD) as it is valid in other medical conditions. Patients with chronic renal disease (CRD) carry the risk of hyperhomocycsteinemia before the hemodialysis (HD) treatment, during the HD treatment, when they are under CAPD treatment or after the renal transplantation.
The mechanisms involved in the pathogenesis of hyperhomocysteinemia seem to be similar with the secondary effects of rhuEPO treatment, which is frequently administered to CRD patients. In our study, we aimed to compare the homocsytein levels and the effects of rhuEPO treatment on these levels in two different groups of patients with renal insufficiency.
The study consisted of 2 groups; Group I consisted of 20 patients who did not take rhuEPO treatment, who never underwent HD treatment or in whom the HD treatment was recently started. Group II consisted of 20 patients who were under rhuEPO treatment and were included in a regular HD program.
The exclusion criteria were; patients with Diabetes mellitus, patients who had blood transfusion in the last 3 months, patients who had additional diseases and/or who were under some medications that could affect the homocycstein and EPO levels. Venous plasma sampling was performed to all patients during fasting in order to study their hemoglobin, vitamin B12, folic acid, creatinine, albumin, and homocycstein levels. All patients were asked about their HD treatment periods and smoking states.
The hyperhomocysteinemia rale is found to be 75% in Group I and 70% in Group II. This finding is in accordance with the literature. No relationship could be demonstrated in between the homocycstein levels and the folic acid, vitamin B12 and creatinine levels. This finding is not in accordance with the literature. However, the homocycstein levels are positively correlated with the albumin levels as in accordance with the literature. On the other hand, the homocystein levels were independent from the CRD etiology and the length of the HD treatment and this also is in accordance with the literature. Our other finding is that, we could not demonstrate any effect of rhuEPO treatment on homocystein levels. This finding is in accordance with the literature. However, this point needs to be illuminated with further prospective studies.
Hyperhomocysteinemia is a risk factor that could lead to important mortality and morbidity in all CRD patients starting from the pre-HD period. Quitting smoking, control of blood pressure, use of cheap and easily available folic acid and vitamin B preparations can be helpful especially when they are started in the early period.