carotid artery stiffness in patients with endstage renal disease no effect of longterm homocysteinelowering therapy background the excess of cardiovascular disease in endstage renal disease esrd patients is unexplained but could relate to altered intrinsic vascular wall properties such as increased arterial stiffness which could be mediated by hyperhomocysteinemia we investigated potential determinants of carotid artery stiffness in esrd patients and the effect of longterm homocysteinelowering treatmentpatients and methods fiftyfour patients on maintenance dialysis treatment were studied at baseline fourtyone patients completed the treatment protocol which consisted of a 12week treatment with folic acid 5 mg daily with or without betaine 4 g per day and of 1 or 5 mg of folic acid thereafter for 40 weeks both phases were randomized compliance and distensibility coefficients cc and dc and the stiffness index beta of the common carotid artery were determined at baseline and after 52 weeks of treatment using a noninvasive vessel wall movement detector systemresults at baseline plasma total homocysteine was elevated 441337 micromoll but showed no relationship with cc dc or beta age and mean arterial pressure map were the only independent determinants of cc and dc whereas beta was associated with age only plasma homocysteine showed a sustained decrease after therapy 20790 micromoll at week 52 no significant changes occurred in cc from 059021 to 060022 mm2kpa p 047 in dc from 14961 to 15362 103kpa p 055 or in beta from 10947 to 11244 p 064 no independent determinants were detected for the change in cc whereas the change in dc was inversely related to the change in map stand r 058 p00002 the decrease in map after therapy was significant p 0003 and was related to the dialysis mode p 0003 and smoking status p 002conclusion folic acid treatment of hyperhomocysteinemia has no major effect on carotid artery stiffness in chronic dialysis patients the results do however emphasize the importance of tight blood pressure control in these patients