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Impact of malnutrition-inflammation on the association between homocysteine and mortality.

Abstract : Whether high total serum homocysteine levels (tHcy) contribute to increase mortality or offer a survival advantage in chronic hemodialysis patients remains controversial. We conducted a prospective study to determine the impact of tHcy on survival in this population with special respect to chronic inflammation-malnutrition state (CIMS). In this prospective study, 459 hemodialysis patients from 10 dialysis centers located in two regions of France were included. A number of baseline parameters were measured including tHcy and markers of CIMS. Over a mean follow-up period of 54 months, 219 deaths (47.7%) occurred, of which 114 (52%) were of cardiovascular (CV) origin. tHcy of equal to or greater than 30 micromol/l was associated with a higher risk of all-cause mortality in patients without CIMS (hazard ratio (HR): 1.55 (confidence interval (CI): 1.12-4.72)), but not in overall dialysis population or those with CIMS. When only CV mortality was considered, tHcy of equal to or greater than 30 micromol/l was associated with a higher risk in patients without (CIMS HR: 1.91 (CI: 1.23-3.23)), but not in those with CIMS. Hyperhomocysteinemia is a strong risk factor for all-cause and CV mortality in hemodialysis patients who do not present CIMS. This association might be masked in patients with CIMS.
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https://www.hal.inserm.fr/inserm-00469490
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Submitted on : Thursday, April 1, 2010 - 3:39:19 PM
Last modification on : Tuesday, October 27, 2020 - 2:35:49 PM

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Didier Ducloux, Alexandre Klein, Amir Kazory, Nadège Devillard, Jean-Marc Chalopin. Impact of malnutrition-inflammation on the association between homocysteine and mortality.. Kidney International, Nature Publishing Group, 2006, 69 (2), pp.331-5. ⟨10.1038/sj.ki.5000096⟩. ⟨inserm-00469490⟩

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