Homocysteine Value as A Risk Predictor of Dialysis Dementia Progression

Background: Dementia is increasingly recognized among hemodialysis patients, and elevated homocysteine has been proposed as a potential contributor to cognitive decline. Identifying biochemical predictors of dialysis-related dementia may help guide early diagnosis and intervention.Aim: To evaluate homocysteine levels in different stages of dementia and assess their correlation with cognitive function in hemodialysis cases.Methods: This case-control research included 60 ESRD cases on maintenance hemodialysis (≥6 months). Participants have been separated into two groups: Group A (n=30) with clinical evidence of dementia and Group B (n=30) without dementia. All patients underwent comprehensive history taking, clinical examination, laboratory testing, including serum homocysteine, and cognitive assessment using the Mini-Mental State Examination (MMSE). Homocysteine levels more than fifteen µmol/L have been deemed elevated.Results: Group A showed significantly higher homocysteine levels (median 40.19 µmol/L) compared to Group B (median 10.15 µmol/L) (p≤0.001), and significantly lower MMSE scores (p≤0.001). Homocysteine levels associated positively with age (r=0.318, p=0.01) and dialysis duration (r=0.333, p=0.01), while MMSE scores associated negatively with age (r=–0.681, p≤0.001). ROC analysis revealed a homocysteine cutoff of 19.56 µmol/L predicting dementia with 96.7% sensitivity and 93.3% specificity. Severity of dementia correlated with declining MMSE scores but not with homocysteine level.Conclusion: Hemodialysis patients with dementia exhibit significantly elevated homocysteine levels and reduced cognitive performance. Homocysteine shows strong predictive value for dialysis-related dementia and correlates with age and dialysis duration. It may serve as an early biomarker for cognitive impairment in ESRD.