Correlationship between Homocysteine and Cardiac Troponin-I with Left Ventricular Hypertrophy in End-Stage Renal Disease Patients

Shin, Byung Chul; Shi, Chung Hyun; Jeong, Ji Yong; Park, Chi Young; Kim, Dong Min; Chung, Jong Hoon; Kim, Hyun Lee

Abstract

BACKGROUND
Cardiovascular disease is the main cause of death in chronic renal failure patients. Left ventricular hypertrophy (LVH) is an independent risk factor for mortality of patients in ESRD and hemoglobin (Hb), hypercholesterolemia and CRP as associated factors for LVH. This study was conducted to determine weather the total homocysteine and cardiac troponin in ESRD patients is related to the LVH as the independent mortality factor of ESRD. METHODS: We assessed the baseline disease status and laboratory variables including total homocysteine and cardiac troponin in 90 patients (58 hemodialysis and 32 peritoneal dialysis). Also, we analyzed the left ventricular mass index (LVMI) and ejection fraction(EF) on echocardiography. RESULTS: The causes of renal disease patients were 32 cases (36%) of diabetic nephropathy, 29 cases (32%) of chronic glomerulonephritis, 26 cases (29%) of hypertensive nephropathy, 2 cases (2%) of polycystic kidney disease and 1 case (1%) of unknown cause. Mean age of patients (male/female: 44/46) was 52.2+/-12.46 years and duration of dialysis was 28.4+/-23.40 months. The prevalence of LVH was 76 cases (84%). The age (52.8+/-11.87 years vs 43.6+/-12.68 years, p<0.05), mean homocysteine levels (18.58 micromol/L, [13.06-21.86 micromol/L] vs 13.12 micromol/L, [11.78-13.47 micromol/L], p<0.01), cardiac troponin-I concentrations (0.1 ng/mL, [0-0.6 ng/mL] vs 0 ng/mL, [0-0.01 ng/mL], p<0.05) and CRP (2.42+/-3.54 mg/dL vs 0.56+/-0.37 mg/dL, p<0.05) were higher on LVH patients than normal LV mass patients. In a multiple logistic regression analysis, including age, duration of dialysis, mode of dialysis, diabetes, hypertension, cTn-I, homocysteine and CRP, both elevation of cTn-I and homocysteine were associated with a 2.91 folds increase in the incident risk of LVH (Odds ratio 2.91, 95% CI 1.14-7.42, p=0.026). LVMI positively correlated with homocysteine (r=0.507, p<0.01), cardiac troponin-I (r=0.339, p<0.01) and CRP (r=0.403, p<0.05). CONCLUSION: High levels of homocysteine and cardiac troponin-I appear together with increased left ventricular mass in patients with ESRD. Regular study of homocysteine, cardiac trophonin-I and CRP levels on ESRD patients will be predictors of LVH and useful markers on prevention of cardiovascular complication.