Elevated homocysteine is a predictor of all-cause mortality in a prospective cohort of renal transplant recipients.

Background: In patients with chronic kidney disease, an elevated homocysteine concentration is associated with an increased incidence of cardiovascular events.

Aim: The aim of this study was to investigate the relationship between homocysteine concentration and all-cause mortality during prospective follow-up of a renal transplant cohort.

Methods: A total of 378 renal transplant recipients were recruited between June 2000 and December 2002. Homocysteine was measured at baseline and mortality data was collected at a median of 2,441 days after enrolment.

Results: In univariate analysis, homocysteine was a significant predictor of mortality (p < 0.001). In multivariate analysis, homocysteine remained a significant independent predictor of mortality following adjustment for traditional cardiovascular risk factors (p = 0.01), vitamin B(12) and folate (p < 0.001) and estimated glomerular filtration rate (p = 0.03).

Conclusions: In the renal transplant recipients enrolled in this study, homocysteine concentration was a significant predictor of mortality in univariate survival analysis and in multivariate survival analysis following adjustment for traditional cardiovascular risk factors and following adjustment for renal function. Assessing the effect of lowering homocysteine concentration on the survival of patients with a renal transplant is therefore worthy of further study.