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Abstract
Summary and conclusion Patients with ESRD exhibit an abnormally high incidence of cardiovascular disease are usually due to cardiomyopathy and ischemic heart disease. Hyperhomocysteinemia is recognized as an independent risk factor for cardiovascular disease, especially atherosclerosis in adult patients with CRF. However, there is a little information about the relationship between plasma homocysteine levels and left ventricular hypertrophy. The aim of this study was to determine relation between plasma homocysteine levels, folic acid, vitamin B12 and cardiac changes in children with CRF; those on conservative treatment and those on regular HD. We tried to evaluate the possible link between Hcy and the presence of clinical evidence of left ventricular hypertrophy in children with chronic renal failure. The present study was carried out at the Pediatric Dialysis Unit, Pediatric Department, Zagazig University during the period from October 2003 to August 2004. Subjects included in this study were classified into two groups. Group I comprised 40 patients; 20 patients suffering from ESRD on regular HD. They included 8 males and 12 females, their ages ranged between 3 to 17 and mean of 10.85 ± 4.36 and 20 patients suffering from CRF under conservative treatment. They include 9 males and 11 females, their ages ranged between 3 and 14 years and mean of 8.35 ± 2.87. Group II comprised 10 control healthy children being aged and sex matched with patients. The following was done to all subjects:Full history taking. Clinical examination. In addition to standard investigations, the level of the following markers were estimated before and after dialysis. 1) Serum homocysteine.2) Serum folic acid.
3) Serum vitamin B12.
4) Cardiac measurements by echocardiography.
Basal serum Hcy was significantly higher in the HD patients with mean ± SD of 128.38 ± 26.35 ?ml/L than the conservative patients with mean ± SD of 58.92 ± 20.63 ?ml/L as compared with the control group with mean ± SD of 9.885 ± 5.87 ?ml/L while there was significant variation between the later two groups.There is no significant variation between level of homocysteine before and after dialysis.Basal serum level of vitamin B12 and folic acid were lower in HD patients with vitamin B12 mean ± SD of 97.6 ± 14.93 ng/dl and folic acid with mean ± SD of 2.44 ± 1.05 ng/dl than the conservative patients with vitamin B12 mean ± SD of 102.63 ± 11.16 ng/dl and folic acid mean ± SD of 6.55 ± 2.88 ng/dl and control with vitamin B12 mean ± SD of 350.56 ± 58.46 ng/dl and folic acid mean ± SD of 12.81 ± 4.49 ng/dl.There is significant variation between level of folic acid and vitamin B12 before and after dialysis.There is highly significant negative correlation between homo-cysteine and both folic acid and vitamin B12.There is significant negative correlation between homocysteine and GFR.Echocardiograhpic findings: We found LVMI was higher in dialysis patients with mean ± SD of 134.8 ± 42.42 gm/m2 than both conservative with mean ± SD of 89.54 ± 21.25 gm/m2 and control group with mean ± SD of 82.13 ± 23.48 gm/m2, and higher in conservative than the control.There is no significant correlation between Hcy and LVMI.Finally, We found a significant positive correlation between homocysteine, SBP, DBP, BUN and creatinine and significant negative correlation between homocysteine, vitamin B12, folic acid, hemoglobin, and albumin.Both LVMI and plasma homocysteine level in the ESRD group were higher than in controls. In contrast to previous results, there was no direct relationship between LVMI and homocysteine. In our view, homocysteine has no direct effect on LV structure.