SUMMARY, CONCLUSION AND RECOMMENDATIONHyperhomocysteinemia is one of the non-traditional risk factor for cardiovascular disease (CVD) in patients with chronic renal failure (CRF). The cause of hyperhomocysteinemia in CRF was suggested to be due to impairment of renal or extra renal metabolism caused by the strongly disturbed renal remethylation of Hcy to methionine which is only partly reversible by vitamin supplementation. Other causes of refractory hyperhomocysteinemia in ESRD patients are the reduced glomerular filtration and deranged tubular reabsorbtion.The present study was conducted on 35 patients with CRF and 15 age and sex matched healthy controls. These patients were selected from Nephrology Unit-Internal Medicine Department, Zagazig University Hospitals. All of them were subjected to full history taking, clinical examination and laboratory investigations including urea, creatinine, creatinine clearance, total protein, albumin, fasting glucose level, lipid profile, quantitative C-reactive protein, total plasma homocysteine level, vitamin B12 and folic acid.From this study the following results can be summerized:• Twenty four patients from CRF group were suffering from CVD (68.5%).• There was a significant increase in systolic and diastolic blood pressure in CRF group compared to control group. Twenty seven patients from CRF were hypertensive (77.1%). Hypertensive patients were 8.35 times more risky to have CVD than non-hypertensive patients (OR = 8.35, 95% CI = 1.36-65.48).• There was a significant decrease in total protein and albumin in CRF group compared to control group.• There was a significant increase in glucose level in CRF group compared to control group. Nineteen patients from CRF were diabetic (54.3%). Diabetic patients were 9 times more risky to have CVD than non-diabetics (OR = 9, 95% CI = 1.28-79.4).• There was a significant increase in total cholesterol, triglycerides and LDL cholesterol and a highly significant decrease in HDL cholesterol in CRF group compared to control group. Twenty five patients from CRF were dyslipidemic (71.4%). Dyslipidemic patients were 8 times risky to have CVD than patients with normal lipid profile (OR = 8, 95% CI = 1.28-57.39).• There was a highly significant increase of total Hcy in CRF group compared to control group. Twenty patients from CRF were hyperhomocysteinemic (57.4%). Hyperhomocysteinemic patients were 6.48 times more risky to have CVD than patients with normal Hcy level (OR = 6.48, 95% CI = 1.07-44.4).• There was a highly significant increase of vitamin B12 and folic acid in CRF group compared to control group.• There was a highly significant increase of CRP levels in CRF group compared to control group.• There was a highly significant positive correlation between Hcy and both urea and creatinine and a highly significant negative correlation between Hcy and creatinine clearance in CRF group.• There was a highly significant negative correlation between Hcy and both vitamin B12 and folic acid.• There was no significant correlation between Hcy and CRP.It was concluded that CRF patients with hyperhomocysteinemia are more risky to have CVD than patients with normal Hcy level. In addition, other risk factors for CVD such as hypertension, diabetes mellitus, dyslipidemia and inflammation are also common in CRF patients. The effect of pharmacologic doses of vitamin supplementation on reduction of Hcy level and risk of CVD in CRF is limited.For the treatment of hyperhomocysteinemia and reducing the risk of CVD in CRF patients, it’s recommended to increase the doses of vitamin supplementation (folic acid and vitamin B12). At the end, renal transplantation with vitamin supplementation is the suitable treatment for ESRD patients in order to decrease the hazards of CVD.