Influence of Homocysteine on the Function of Native Arteriovenous Fistula in Hemodialysis Patients

Background Vascular access (VA) for hemodialysis (HD) is crucial for the course of treatment and a good prognosis for patients. There have been numerous investigations of the influence of homocysteine (Hcy) on VA complications, but to date the role of Hcy is controversial. The present study of HD patients was designed to investigate the relationship between previous VA failure (VAF) and the serum level of Hcy and other routinely measured biochemical parameters. Patients and Methods Eighty‐five patients participated in the study. Their mean age was 62 years, and their mean duration on HD treatment was 33 months. Incidence of VAF over the preceding 18 months was analyzed retrospectively. VAF was defined as any dysfunction of VA that required a different surgical intervention. Serum levels of Hcy and several other biochemical parameters related to the adequacy of HD, osteodystrophy, nutrition status, and atherosclerosis were determined. In addition, body mass index, normalized protein catabolic rate, and mean blood pressure were calculated. Additionally, the serum level of Hcy was determined in a healthy control group (n=12). Results VAF, as venous or graft thrombosis (n=12) and stenosis of anastomosis (n=13), was observed in 25 of the HD patients (30%). Mean Hcy level was significantly higher in the HD patients than in the control group (26.8±9.5 vs. 11.8±2.9 μmol/L, p  <.01). Mean Hcy level was significantly higher in patients with VAF than in the other HD patients (31.8±10.3 vs. 25.1±8.5 μmol/L, p <.005). There were no differences in age, duration of HD, and cause of renal failure, as well as in the other measured parameters, between these groups of patients. Conclusion Patients with extremely elevated Hcy levels had higher incidences of VAF, and needed surgical intervention more frequently.