Homocysteine and vascular access thrombosis in end-stage renal disease patients: a retrospective study

BACKGROUND: Though pathology in end-stage renal disease (ESRD) patients with high total homocysteine (tHcy) can be established, the research findings with vascular access thrombosis (VAT) and tHcy are equivocal. Investigators have found significantly higher homocysteine levels in patients with recurrent VAT compared with one or less episodes of thrombosis. Initial prospective evidence supports an independent association between tHcy levels and access thrombosis. METHODS: One hundred and four patients undergoing dialysis were selected. The experimental group participants were identified as those having one or more vascular access thromboses (VAT) during the previous 14-month period (November 2000 to January 2002) and the control group participants were those with no VAT during the same period. Additional sub-group analyses included the following: a) hypertensive vs. normotensive; b) diabetes mellitus, Type I, Type II, and none; c) gender; d) age. RESULTS: The Mann-Whitney U test for variance revealed no significant difference in tHcy values between VAT groups (U = 1580.5, p = 0.075), no significant differences in VAT and hypertension (U = 1009.0, p = 0.70), and no significant differences in VAT and Diabetes Mellitus (U = 1254.5, p = 0.67). A two-sample t-Test revealed no significant differences in tHcy and age (F-ratio = 1.26, p = 0.47). A Kolmogorov Smirnov test for normality revealed insufficient evidence that the tHcy distribution is not normal. Spearman Rank Correlations were calculated revealing low to moderate associations among variables. CONCLUSIONS: While some studies have demonstrated a relationship between tHcy and VAT, this study found chronically high homocysteine levels in patients with ESRD were not associated with incidence of VAT. There were no significant differences in the number of VAT's across additional variables of age, gender, and previous morbidity. No significant interactions were discovered.