caa a22 4500 378876147 CHVBK 20180305123421.0 cr unu---uuuuu 161128e20030515xx s 000 0 eng 10.1515/CCLM.2003.102 doi (NATIONALLICENCE)gruyter-10.1515/CCLM.2003.102 Hyperhomocysteinemia and End-Stage Renal Disease: Determinants and Association with Cardiovascular Disease in Tunisian Patients [Elektronische Daten] [Hayet Fellah, Moncef Feki, Mohamed Hsairi, Haifa Sanhaji, Neziha Kaabachi, Taieb Ben Abdallah, Ziad A. Massy, Hedi Ben Maiz, Bernard Lacour, Abderraouf Mebazaa] The study reports on plasma total homocysteine (tHcy) levels in Tunisian patients with chronic renal failure (CRF) and those treated with hemodialysis (HD) and renal transplant (RT). The aims of the study were to identify the determinants of tHcy concentration and to test the association between hyperhomocysteinemia and atherothrombotic disease in end-stage renal disease (ESRD). A total of 35 CRF patients on conservative treatment, 50 HD patients, and 30 RT recipients, and 31 age-and sex-matched healthy subjects were included. Plasma tHcy was assessed by a fluorescent-polarizing immunoassay method. Multivariate analysis was applied to identify the main determinants of tHcy concentration and to assess the relationship between hyperhomocysteinemia and cardiovascular disease. Plasma mean tHcy concentration was significantly increased (p < 0.001) in CRF patients (mean ± SD) (28.9±9.8 μmol/l), in HD patients (29.4±11.1 μmol/l), and in RT (19.3±6.3 μmol/l) patients compared to controls (11.9±4.1 μmol/l). Multivariate analysis using GLM ANOVA modeling demonstrated that tHcy was significantly higher in males (p = 0.02), and was related to age (p = 0.008), albumin (p = 0.005), vitamin B12 (p = 0.002), folate (p = 0.00001), and creatinine clearance (p = 0.0008). However, tHcy was not associated with C-reactive protein and did not significantly differ between CRF, HD, or RT patients. The upper quartile of tHcy concentration was significantly associated with atherothrombotic cardiovascular disease (unadjusted odds ratio (OR) = 3.09; 95% CI, 1.11-8.61; p = 0.01). This association remained significant after adjusting for sex, age, hypertension, and smoking (multi-adjusted OR = 4.78; 95% CI, 1.92-11.9; p = 0.0008). The mean tHcy concentration was 2 to 3 times higher in ESRD patients than in subjects with normal renal function. This increase could be related to glomerular filtration rate reduction and functional B vitamins deficiency, but was not associated with inflammation. The upper quartile of tHcy concentrations confers 4.78-fold increased independent risk for atherothrombotic events in ESRD patients. Copyright © 2003 by Walter de Gruyter GmbH & Co. KG Medical equipment & techniques nationallicence Medical diagnosis nationallicence Diseases & disorders nationallicence Fellah Hayet aut Feki Moncef aut Hsairi Mohamed aut Sanhaji Haifa aut Kaabachi Neziha aut Abdallah Taieb Ben aut Massy Ziad A. aut Maiz Hedi Ben aut Lacour Bernard aut Mebazaa Abderraouf aut Clinical Chemistry and Laboratory Medicine Walter de Gruyter 41/5(2003-05-15), 675-680 1434-6621 41:5<675 2003 41 cclm https://doi.org/10.1515/CCLM.2003.102 text/html Onlinezugriff via DOI 1 research article jats NATIONALLICENCE 856 40 https://doi.org/10.1515/CCLM.2003.102 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Fellah Hayet aut NATIONALLICENCE 700 1- Feki Moncef aut NATIONALLICENCE 700 1- Hsairi Mohamed aut NATIONALLICENCE 700 1- Sanhaji Haifa aut NATIONALLICENCE 700 1- Kaabachi Neziha aut NATIONALLICENCE 700 1- Abdallah Taieb Ben aut NATIONALLICENCE 700 1- Massy Ziad A. aut NATIONALLICENCE 700 1- Maiz Hedi Ben aut NATIONALLICENCE 700 1- Lacour Bernard aut NATIONALLICENCE 700 1- Mebazaa Abderraouf aut NATIONALLICENCE 773 0- Clinical Chemistry and Laboratory Medicine Walter de Gruyter 41/5(2003-05-15), 675-680 1434-6621 41:5<675 2003 41 cclm CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-gruyter