Prevalence of hyperhomocysteinemia in thai CKD patients and relationship to cardiovascular events: Subgroup analysis from thai SEEK study

Objective: It is well recognized that patients with chronic kidney disease [CKD] have an increased risk for cardiovascular disease [CVD]. Hyperhomocysteinemia appears to be a predictor of future CVD events. The prevalence of hyperhomocysteinemia in Thai CKD patients by using the Thai Screening and Early Evaluation of Kidney Disease [SEEK] study database and its relationship to CVD were studied. Materials and Methods: Ninety-eight subjects were randomly sampled from the Thai SEEK study database. Traditional risk factors for CVD were examined and recorded. Stored sera of the subjects were analyzed for their total homocysteine [tHcy] level and its association with CKD and CVD. Results: 72 subjects with CKD stage I-IV and 26 subjects without CKD were included. Fourteen subjects (14.3%) had CVD. Ten of them were in CKD stage III or higher. Only older age, CKD stage III, or elevated urine albumin/creatinine ratio (>300 mg/g) were associated with the presence of CVD. Mean plasma tHcy of only stage IV CKD, but not in the other stages, was significantly higher than in non-CKD group (14.56+7.96 µmol/L vs. 8.68+8.75 µmol/L, p = 0.016). Plasma tHcy level (>15µmol/l) was not associated with CVD or its risk factors. Only older age, CKD stage III or more and high urine albumin/ creatinine ratio (>300 mg/g) were associated with the presence of CVD. Conclusion: Hyperhomocysteinemia is more prevalent in advanced stage CKD. Traditional factors are not related to tHcy levels. CKD stages, older age and higher urine albumin-creatinine ratio were associated with CVD. Hyperhomocysteinemia may have an indirect relationship to development of CVD in later CKD stage.