Low total plasma homocysteine level in relation to malnutrition, inflammation, and outcome in hemodialysis patients.

OBJECTIVE: We examined the association between nutritional status and total plasma homocysteine (tHcy) level, cardiovascular disease (CVD), and mortality in hemodialysis (HD) patients.

DESIGN: This prospective study consisted of 124 HD patients. A number of baseline parameters were measured, including tHcy level and laboratory markers of nutrition and inflammation. A CVD history and a malnutrition-inflammation score (MIS) were determined in all patients. The follow-up period was 2 years.

RESULTS: Forty-nine patients (39.8%) had a history of CVD. During follow-up, 11 (8.8%) deaths occurred, and of these 7 deaths were attributable to CVD. A low tHcy level and an increased MIS were associated with CVD and mortality. The rates of CVD and mortality were also higher in the lowest tHcy level tertiles. In addition, tHcy level was positively correlated with albumin and creatinine, and was negatively correlated with C-reactive protein, MIS, and comorbidity. The survival rates in Kaplan-Meier survival analysis tests were significantly lower in patients with the highest MIS (log rank, 22.3; P < .001). Patients with higher tHcy levels had significantly longer survival rates (log rank, 9.7; P = .007).

CONCLUSIONS: Because of the strong association of tHcy levels with malnutrition- inflammation, the presence of these factors should be considered when tHcy is evaluated as a risk factor of outcomes in HD patients.