Diabetes mellitus, hyperhomocystinemia and atherosclerotic vascular disease in Taiwanese chronic hemodialysis patients: A retrospective study

Aim: Diabetic patients with hemodialysis (HD) have a high mortality rate from atherosclerotic vascular disease (ASVD). However, the extent of the role of hyperhomocystinemia as a risk factor of ASVD is uncertain in diabetic HD patients. We investigated whether there was an association with ASVD events in diabetics and non-diabetics where these were chronic hyperhomocystinemia HD patients. Methods: Two hundred patients undergoing HD were included in the study. About 50% of the patients had diabetes mellitus (DM). They had predialysis blood work performed for total homocysteine. A history of DM was elicited using information from the patients' questionnaires and verified by careful inpatient and outpatient chart review. Results: A total of 196 patients had hyperhomocystinemia and were enrolled this study. Mean homocysteine concentration was 29.7 ± 6.6 μmol/L overall. DM was present in 50.0% of patients. The mean homocysteine concentration was 29.4 ± 9.5 μmol/L and 29.9 ± 9.7 μmol/L in diabetic HD patients (n=98) and non-diabetic HD patients (n=98), respectively (P=0.71). There was no association with hyperhomocystinemia between diabetic and non-diabetic in chronic HD patients. There were significant differences including age, sex, HDL cholesterol, triglycerides, hypertension, smoking, serum creatinine, dialysis duration and glucose intolerance in the two groups (P<0.05). There were also significant differences in ASVD (P=0.0027) and CVD (P=0.0017) between diabetics and non-diabetics in cases of chronic hyperhomocystinemia HD patients. The adjusted odds ratio for ASVD was 3.02 (95%CI, 1.63 to 5.59) for those subjects with a DM in the highest quartile compared with the lowest 3 quartiles. Conclusions: There were associations with ASVD and CVD in diabetics and non-diabetics in cases of chronic hyperhomocystinemia HD patients. There was no association with hyperhomocystinemia between diabetic and non-diabetic in Taiwanese chronic HD patients. This study found that the presence of DM and advanced age were the major determinants for ASVD events in chronic HD patients, rather than the levels of homocysteine.