Effect of Anemia and Hyperhomocysteinemia on Mortality of Patients on Hemodialysis

Anemia and hyperhomocysteinemia are risk factorof mortality of patients on dialysis. This study was conducted toassess the relationship of hemoglobin and homocysteine levelsand mortality of patients on hemodialysis.Materials and Methods. Fifty patients on hemodialysis and 20healthy individuals were enrolled in the study. Blood sampleswere drawn for measurement of hematological parameters, serumiron, serum ferritin, transferrin saturation, and homocysteinelevels. The patients were followed up for 1 year to determinethe mortality rate and evaluate its association with anemia andhyperhomocysteinemia.Results. The majority the patients (54%) were not on erythropoietintherapy. Forty-three patients (86%) were anemic (hemoglobin 11 g/dL). Serum ferritin was high ( 500 ng/mL) in 33 patients(66%). Mortality was 28% in 1 year (33% in anemic patients versusno death among patients with a hemoglobin level greater than11 g/dL). The relative risk of mortality was increased by 1.58 withevery 1 g/dL decrease in hemoglobin level. All of the patients had ahigh homocysteine level, and a significant difference was observedbetween the homocysteine levels of the patients on hemodialysisand the control group (P .001). Hyperhomocysteinemia did notaffect mortality. In multivariate Cox regression analysis, onlyhemoglobin level was associated with mortality.Conclusions. Almost all of our patients on hemodialysis wereanemic and this condition was a risk factor of mortality. Ironstores, however, were adequate in more than half of the patients.The reason of anemia could be untreated erythropoietin deficiency.Hyperhomocysteinemia was present in the majority of the patients,but it did not independently affect mortality.