Homocysteine and Hematological Indices in Hemodialysis Patients at Al-Shifa Hospital, Gaza Strip

Background: Renal failure constitutes one of the ten leading causes of death in the Gaza strip with mortality rate of 2.8%. Although hyperhomocysteinemia has been strongly linked to end stage renal disease, biochemical test is restricted to monitoring kidney function. Therefore, introducing homocysteine as a biomarker of ESRD in Gaza hospitals is recommended. Objective: To assess homocysteine and hematological indices in hemodialysis patients at Al-Shifa hospital, Gaza Strip. Material and methods: This case-control study comprised 60 hemodialysis patients and 60 healthy controls. Questionnaire interview was applied. Serum homocysteine, urea and creatinine, white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count, prothrompin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were determined. Data were analyzed using SPSS version 18.0. Results: End stage renal disease was more prevalent among lower educated and unemployed individuals, families with low income as well as among individuals with family history of the disease. Clinical data showed that hypertension and diabetes are the most common self-reported disorders among the hemodialysis patients. Serum homocysteine was significantly higher in cases compared to controls (50.8±9.7 vs. 13.1±3.7 μmol/l, P=0.000). Serum urea and creatinine were also found to be significantly higher in cases (169.6±42.4 and 9.96±2.40 mg/dl, respectively) compared to controls (27.4±7.1 and 0.77±0.14 mg/dl) with P=0.000. White blood cell count, MCHC and platelet count were significantly increased in cases compared to controls (7.18±1.37 x103 cell/ml, 33.8±1.2 mg/dl and 266.3±104.2 x109 L vs 5.95±1.37 x103 cell/ml, 28.4±2.0 mg/dl and 222.0±54.1 x109 L) with P=0.017, P=0.000 and 0.045, respectively. In contrast, RBC count, hemoglobin, hematocrit and MCH showed significant decreases in cases(3.12±0.54 x106 cell/ml, 8.9±1.5 gm/dl, 26.3±4.6% and 28.6±2.9 pg) compared to controls (4.03±0.37 x106 cell/ml, 12.8±1.6 gm/dl, 45.0±4.6% and 31.9±4.4 pg) with P<0.01. Prothrompin time and INR were significantly higher in cases compared to controls (16.2±2.6 sec and 1.23±0.17 vs 13.5±0.4 sec and 0.97±0.07, P=0.000), whereas APTT was decreased in cases (25.3±5.3 vs 32.6±2.1 sec, P=0.000). Homocysteine levels were higher among lower educated and unemployed individuals, families with low income as well as among individuals with family history of ESRD (P<0.01). Homocysteine was positively correlated with urea (r=0.827, P=0.000), creatinine (r=0.842, P=0.000), WBC count (r=0.338, P=0.008), MCHC (r=0.789, P=0.000) and platelet count (r=0.369, P=0.000) whereas negative correlations were found between homocysteine and RBC count (r=-0.648, P=0.000), hemoglobin (r=-0.733, P=0.000), hematocrit (r=-0.836, P=0.000) and MCH values (r=-0.402, P=0.001). In addition, homocysteine showed positive correlations with PT (r=0.564, P=0.000) and INR (r=0.657, P=0.000) and negative correlation with APTT (r=-0.690, P=0.000). Conclusions: Serum homocysteine was significantly higher in hemodialysis patients compared to controls. Homocysteine was positively correlated with urea, creatinine, WBC count, MCHC, platelet count, PT and INR, and negatively correlated with RBC count, hemoglobin, hematocrit, MCH and APTT

Homocysteine and hematological indices in hemodialysis patients

Objectives: To explore the relationship between homocysteine and various hematological indices in hemodialysis patients. Patients and Methods: This case-control study comprised 60 hemodialysis patients and 60 healthy controls matched for gender and age. Hemodialysis duration was 3.2±2.9 year at frequency of 2.6±0.6/week. Hypertension and diabetes were the most common self-reported disorders among the hemodialysis patients. Results: Serum homocysteine was significantly higher in hemodialysis patients than in controls (50.8±9.7 vs. 13.1±3.7 μmol/l, P= 0.000). White blood cell (WBC) and platelet (PLT) counts were significantly higher in hemodialysis patients than in controls [(7.18±2.37 x109/L and 266.3±111.9 x109/L vs 5.95±1.37 x109/L and 222.0±54.1 x109/L) with P= 0.017 and P= 0.045, respectively]. In contrast, red blood cell (RBC), hemoglobin, and hematocrit were significantly lower in hemodialysis patients (3.1±0.5 x1012/L, 8.9±1.5 gm/dl and 26.3±4.6%) than in controls (4.0±0.4 x1012/L, 12.8±1.6 gm/dl and 45.0±4.6%) with P= 0.000. Prothrombin time (PT) and international normalized ratio (INR) were significantly higher in hemodialysis patients compared to controls (16±3 sec and 1±0 vs. 14±0 sec and 1.0±0.1, P= 0.000), whereas activated partial thromboplastin time (APTT) was significantly decreased in hemodialysis patients (25±5 vs 33±2 sec, P= 0.000). Homocysteine correlated directly with WBC count (r= 0.338, P= 0.008) and PLT count (r= 0.369, P= 0.000) whereas inverse correlations were found between homocysteine and RBC count (r=-0.648, P= 0.000), hemoglobin (r=-0.733, P= 0.000) and hematocrit (r=-0.836