THE EFFECT OF ADEQUATE HEMODIALYSIS ON HOMOCYSTEINE LEVELS IN PATIENTS WITH CHRONIC RENAL FAILURE

BACKGROUND: Hyperhomocysteinaemia, which is an independent cardiovascular risk factor, is common in chronic haemodialysis (HD) patients. In chronic haemodialysis patients, the effect of dialysis adequacy on homocysteine levels is object of research. Treatment with folic acid lowers tHcy in haemodialysis patients. However, in most patients normohomocysteinaemic levels can not be provided. We studied the influence of dialysis adequacy on homocysteine levels. 

MATERIAL and METHOD: Thirty patients were taken in this study. They had entered in dialysis for more than one years and also taken Bl2 and folic acid. Kt/V ratios, serum albumine, folic acid, Bl2, predialysis and postdialysis total serum homocysteine (tsHcy) were measured in-patients. Non-parametric 'Wilcoxon's rank, Spearman rank correlation and multiple linear regression' tests were used in statistically analysis. 

RESULTS: tsHcy were found predialysis as 10.7+9.0 (3.55-37.7) μmol/L and postdialysis 5.3+4.29 (2.25- 23.85) μmol/L (p=0.004). Predialysis tsHcy correlated significantly with Kt/V 1.26+0.15 (0.86-1.5) and serum concentrations of albumin 3.58+0.39 (2.7-4.2) gr/dl (r=-0.621, p<0.0001, r=-0.764, p<0.0001) respectively. There was not a meaningful relation between tsHcy and serum cobalamines 637.5±181.7 (260-983) pg/ml (r=-0.3, p=0.107). In contrary tsHcy correlated significantly with serum folic acid 12.2±5.2 (3-20) ng/ml (r=-0.830, p<0.0001). In a multiple linear regression analysis, Kt/V and serum folic acid levels significantly predicted tsHcy (r=-0.387, p=0.003, r=-0,487, p=0.001).

CONCLUSIONS: It was seen that there was a meaningful relation between tsHcy and Kt/V, serum concentrations of albumin and folic acid levels. In conclusion; dialysis adequacy, serum concentrations of albumin and folic acid are effective factors on tsHcv levels.