Renal disease, homocysteine, and cardiovascular complications.

Cardiovascular morbidity and mortality remain major problems in the end stage renal disease population.1 Patients with mild or moderate degrees of renal insufficiency are also at increased risk of a similar fate.2 The causes of this poor cardiovascular prognosis in patients with renal disease are complex although many abnormalities occur in patients with renal dysfunction which predispose to such complications. Prime among these must be hypertension and diabetes, but other abnormalities also occur, including disorders of lipid metabolism.3 In the Hoorn study of mild renal insufficiency,2 other significant risk factors for cardiovascular mortality included age, body mass index, a rising pulse pressure, and a prior history of cardiovascular disease. Increasing levels of C-reactive protein, von Willebrand factor, soluble vascular cell adhesion molecule 1, and serum creatinine, as well as the presence of microalbuminuria, were also significant. In addition, increases of asymmetric dimethylarginine have been noted in patients with early chronic renal disease.4 It is unclear if some of these abnormalities are a cause or a result of the underlying metabolic derangement produced by renal dysfunction.