CORRELATION OF SERUM HOMOCYSTEINE LEVELS WITH CAROTID ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Amol Bhawane; Shankar Lal Jat; OP Kalra; G.S. Ranga; Pratibha Maan

Volume : VIII, Issue : XI, November - 2019

CORRELATION OF SERUM HOMOCYSTEINE LEVELS WITH CAROTID ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Amol Bhawane, Shankar Lal Jat, Op Kalra, G. S. Ranga, Pratibha Maan

Abstract :

INTRODUCTION: Chronic kidney disease (CKD) is associated with significantly increased morbidity and mortality. Hyperhomocysteinemia (>15 µmol/l) is one of the such risk factors2 for CVD in CKD patients. Hyperhomocysteinemia is observed in at least 85% patients with ESRD3. With this background in mind, the present study was designed to assess severity of hyperhomocysteinemia in advanced stages of CKD and find a correlation between Hcy and carotid intima media thickness in Indian population. To assess serum homocysteine levels in patients with stage 3, 4 and 5 CKD and compare with healthy controls. To assess correlation of serum homocysteine levels with CIMT as determined by high resolution carotid ultrasound. METHODS: A total of 66 subjects aged 20–60 years were recruited and divided into the following groups . Group A – healthy controls (n=22) Group B – stage 3 and 4 CKD (n=22) Group C – stage 5 CKD (n=22) on the basis of history, physical examination, hematological and biochemical investigations (blood urea, serum creatinine and GFR values), attending Medical OPD, Nephrology clinic, Medical Emergency or admitted in Medical Wards not meeting any of the exclusion criteria were included in the study. RESULTS: In our study mean serum homocysteine levels in group A was 9.1±3.37 µmol/l) with a median 8.16 µmol/l and a range of 4.8–18.5 µmol/l, in group B mean homocysteine level was 22.0±3.10 µmol/l with a median 22.21 µmol/l and a range of 16.2–28.0 µmol/l. in group C pre dialysis mean homocysteine level was 29.6±4.90 µmol/l with a median 29.68 µmol/l and range 21.0–37.7 µmol/l while in group C post dialysis mean homocysteine level was 23.0±4.20 µmol/l with a Median 21.73 and range 17.2–30.1 µmol/l. Thus, homocysteine levels in CKD patients were significantly higher in (>4 times) than controls (p <0.000). In our study we tried to find out correlation between homocysteine and carotid intima–media thickness in various study groups. We found that serum homocysteine levels were higher in patients of CKD and with increase in severity of renal disease, CIMT also showed an increase. There was positive correlation between serum homocysteine level and CIMT (r=0.311) and this correlation was found to be statistically significant (p<0.001). CONCLUSION: • Mean serum homocysteine levels in CKD patients were significantly higher in (>4 times) than controls (p <0.000) • There was positive correlation between serum homocysteine level and CIMT (r=0.311) and this correlation was found to be statistically significant (p<0.001).