말기신부전 환자에서 심혈관계 합병증 예측인자로서의 호모시스테인의 의의 = The Efficacy of Homocysteine on Diagnosis of Cardiovascular Risk Factor in Patients with End-Stage Renal Disease

다국어 초록 (Multilingual Abstract)

Backgroud: Thromboembolic phenomena are major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). In the last years, the accumulation of evidence coming from studies in patients with chronic renal failure have demonstrated an increased relative risk of coronary artery disease (CAD) in association with hyperhomocysteinemia. We elucidate the effects of homocysteine on diagnostic marker of cardiovascular risk factor of patients with ESRD. Methods: One hundred thirty-three patients were enrolled in the study performed at a Chosun university hospital. Ninety patients were on dialysis (58 hemodialyzed patients and 32 peritoneal dialyzed patients). Hyperhomocysteinemia was defined as a fasting plasma homocysteine level more than 15 μmol/L. Results: A total 71 patients (53.4%) had hyperhomocysteinemia. The prevalence of hyperhomocysteinemia was 60.3%, 46.9%, 48.8% among hemodialysis, peritoneal dialysis and kidney transplantation, respectively. CAD was present in 40.6% of patients (54 patients). The mean homocysteine concentration was 22.35 ± 5.94 μmol/L and 15.07 ± 5.45 μmol/L in patient with (n=54) and without (n=79) CAD, respectively (p<0.01). There was significant difference including age, serum creatinine, cardiac troponin-T (cTn-T), homocysteine level, total cholesterol, CRP in the two group (p<0.05). Plasma homocysteine concentration showed significant positive correlations with age (r= 0.261, p<0.05), cTn-T (r= 0.244, p<0.05), CRP (r= 0.422, p<0.01) in overall and negative correlations with hemoglobin (r= -0.240, p<0.05) in dialysis patients. Conclusion: Hyperhomocysteinemia, elevation of cTn-T, and elevation of CRP were diagnostic markers of ischemic heart disease of ESRD patients undergoing hemodialysis and peritoneal dialysis. The homocysteine is more potential diagnostic marker than cTn-T and CK-MB in ischemic heart disease with ESRD patients.