Hyperhomocysteinemia in chronic renal failure and its role in repeated vascular access thrombosis in patients on regular hemodialysis

الملخص EN

This study was performed on 79 patients with chronic renal failure (CRF) in Assiut University Hospital through the year 2006-2007 in the dialysis unit and 20 apparently healthy subjects as a reference group, they were classified as following: Group I; 20 healthy subjects, Group II; 24 patients who will start dialysis for the first time, Group III; 55 patients on maintenance hemodialysis for more than 3 years.

Group III was sub-classified according to the presence of repeated arterio-venous fistula occlusion and thrombosis into: Group III a; 25 patients without repeated arterio-venous fistula occlusion and, Group III b; 30 patients with repeated (3 or more) fistula occlusion.

After careful history and clinical examination, the following was done : A) Routine investigations: Peripheral hemogram, serum glucose, urea and creatinine and creatinine clearance, total serum protein and serum albumin as well as serum lipid profile.

B) Special investigations: total plasma homocysteine.

The results of this study showed no significant difference when comparing group Illb with group Ilia regarding kidney function (serum urea, creatinine and creatinine clearance), serum total protein and albumin as well as all components of the lipid profile.

Homocysteine showed highly statistically significant elevation when comparing each of groups II.

Ilia and Illb with group I, but there was no statistically significant difference when comparing group II with group III.

However, there was highly statistically significant elevation when comparing group III b with group III a.

We concluded that hyper-homocysteinmia in patients with end stage renal disease could be considered a risk factor for the development of repeated vascular access thrombosis (VA T) or occlusion.