Study of Prevalence of Hyperhomocysteinemia in Chronic Kidney Diseasepatients at Tertiary Care Hospital in Northwest Maharashtra

Abstract

Introduction-Chronic Kidney Disease is growing problem across all over world and India as well. Chronic kidney disease encompasses a spectrum of different pathophysiological processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate(GFR).The risk for cardiovascular disease (CVD) morbidity and mortality remains high in all stages of CKD, including in patients with hemodialysis. More patients with CKD die of CVD than of the progression of kidney failure.The increase of homocysteine level, referred as hyperhomocysteinemia, is highly prevalent in CKD patients and associated with an increased risk of CVD complications. Proposed mechanisms for hyperhomocysteinemia in kidney failure is due to reduced clearance of total plasma homocysteine (tHcy) secondary to defective kidney and/or extra kidney metabolism of tHcy and deficiencies of folate, vitamin B12, and pyridoxal 5-phosphate (PLP). Aim-To study Serum Homocysteine levels in patients with Chronickidney disease and to estimate Serum Homocysteine levels in different stages of Chronic kidney disease. Materials And Methods- All the patients presenting with clinical, biochemical and ultrasound kidney evidence of chronic kidney disease in department of medicine at tertiary care centre in northern Maharashtra. Normal plasma homocysteine level was considered to bebelow 15 umol/litre. Results- A study of 54 patients with Chronic Kidney disease of both sex were taken as sample. Of the 54 patients 38 were males and 16 were females .36 patients were in age range of 41-60 . 32 patients were in stage 5 CKD , 14 were in stage 4 CKD , 8 were in stage 3 CKD. Hyperhomocysteinemia was observed in 78 % of CKD patients. Serum Homocysteinemia levels were maximum in patients with higher grade of CKD. The associationbetween decreased GFR and increase in serum homocysteine levels was found to be statistically significant. (p<0.05). Conclusion-Study concludes that hyperhomocysteinemia is highly prevalent in CKD patients. Homocysteine is commonly considered as toxicthrombogenic amino acid which causes atherosclerosis and cardiovascular diseases. Mortality due to cardiovascular diseases is high in CKD. Hence early screening and treatment for Hyperhomocysteinemia should be done in CKD to prevent cardiovascular diseases.

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