In chronic renal failure, high plasma homocysteine levels are a common finding and in uremia almost the rule. The cause of hyperhomocysteinemia in ESRD (end stage renal disease) whether it lies in an impared renal or extrarenal metabolism or through uremic retention toxins, is still under intensive studies.
Present study aimed at evaluating the relationship of p-Hcy (plasma homocysteine) together with serum vitamin B12 and Folate concentrations in ESRD patients under chronic dialysis treatment. This group of patients is characterized by an elevated mortality rate for cardiovascular and cerebrovascular diseases with their high response to develop atherosclerotic vascular disease. It was also compared whether p-Hcy, Vit-B12 and Folate variability occured between hemodialysis and periton dialysis processes.
A total of 76 cases with ESRD were included in the study (40M, 36F and the mean age was 43.28 ± 12.58). Among them, 61 patients were treated with hemodialysis and 15 were treated with periton dialysis. The mean time of dialysis treatment of the whole patients was 25.2 ± 14 months. They were selected those from who have been clinically stable for last 3 months. All cases were dialysed three times a week for four hours on each session using bicarbonate bath. None of them was administered any vitamin preparates during the study. All subjects were tested in the fasting state for the Hcy, serum folate, and serum vitamine B12. Control group was composed of 70 healthy subjects (31 female, 39 male and the mean age was: 45.3 ± 21).
Measurement of Plasma Total Homocysteine: The Hcy assays were performed by Fluorescence Polarization Immunoassay. Vitamin B12 and Folate were assayed manually with Radioimmunoassay method.
Statistical Analysis: The mean and SD values were calculated by student-t test and significances were assayed by 2-tailed significance test. Pearson Corelation analysis was used for predicting correlations.
According to our results, plasma Hcys levels significantly increased (p< 0.001) in ESRD patients compared to that of control group whereas, vitamin B12 and Folate levels did not show any difference. When we investigated these three parameters with respect to dialysis technique used, it was not any significant difference in the values of Hcys, vitamin B12 and Folate between HD and PD patients. The correlation between Hcys and vitamin B12 (r= - 0.292, p= 0.024) and Hcys and Folate (r= -0.423, p= 0.001), were statistically significant .
Our investigation is clearly demonstrate that in contrast to some other reports suggesting significant relationship present between serum folate and ESRD-related hyperhomocysteinemia, hyperhomocysteinemia indepently seems to be a consequence as well as a complicating factor of renal failure. In respect to methods of dialysis, hemodialysis and periton dialysis have the similar risk of atherogenity related to homocysteine.