| Theme |
Arteriosclerosis in Hemodialysis Patient |
| Title |
Hyperhomocysteinemia in dialysis patient |
| Author |
Hideki Kimura |
Department of Clinical Laboratory Medicine and Nephrology, Faculty of Medicine, Fukui Medical University |
| Author |
Satoru Suzuki |
Department of Clinical Laboratory Medicine and Nephrology, Faculty of Medicine, Fukui Medical University |
| Author |
Haruyoshi Yoshida |
Department of Clinical Laboratory Medicine and Nephrology, Faculty of Medicine, Fukui Medical University |
| [ Summary ] |
Recently, increased serum levels of homocysteine (Hcy) have received much attention as a new risk factor for cardiovascular disease. Hcy not only causes endothelial cell injury and smooth muscle cell proliferation but also has thrombogenic and antifibrinolytic effects via oxidative stress generated during auto-oxidation of Hcy. These Hcy's effects are considered to take an important role in progression of atherosclerosis. Uremic conditions lead to accumulation of Hcy in blood because of reduced remethylation of Hcy to methionine in impaired renal function. Dialysis patients usually have 2 to 3 times higher levels of Hcy (2O to 30 micro mol/l) than those of healthy controls, and many recent studies have reported positive associations between hyperhomocysteinemia and cardiovascular disease in this setting. Most recently, several therapeutic trials have revealed that oral supplementation with 15mg of folic acid per day resulted in a reduction in serum Hcy levels of about 30% in dialysis patients. However, some large-scaled prospective studies should be in the near future performed to clarify precisely the clinical significance of hyperhomocysteinemia and its lowering therapy in uremic patients. |