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Hyperhomocyst(e)inaemia in children with chronic renal failure
M Lilien1, M Duran, K Van Hoeck
1Pediatric Renal Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Children with chronic renal failure have elevated plasma homocyst(e)ine levels, a risk factor for atherosclerosis. These high levels are present even before end-stage renal disease and persist after transplantation.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Risk Factors
- Metabolic Disorders
Background:
- Hyperhomocyst(e)inaemia is a known risk factor for atherosclerosis in adults with chronic renal failure.
- The impact of hyperhomocyst(e)inaemia on atherosclerosis risk in children with chronic renal failure was previously unstudied.
- Elevated homocyst(e)ine may directly harm the vascular wall in pediatric chronic renal failure patients.
Purpose of the Study:
- To investigate plasma homocyst(e)ine levels in children with chronic renal failure.
- To compare homocyst(e)ine levels across different stages of chronic renal failure: conservative management, hemodialysis, and post-renal transplant.
- To establish baseline data on hyperhomocyst(e)inaemia in pediatric chronic renal failure.
Main Methods:
- Studied 16 children on conservative management, 12 on hemodialysis, and 17 with renal transplants.
- Used age-matched healthy children as controls.
- Measured plasma homocyst(e)ine via HPLC and estimated glomerular filtration rate (GFR) using the Schwartz formula.
Main Results:
- Significantly elevated plasma homocyst(e)ine levels were found in all pediatric chronic renal failure groups compared to controls.
- Homocyst(e)ine levels were higher in children undergoing hemodialysis (22.2 +/- 13.5 micromol/l) compared to conservatively managed (12.6 +/- 5.2 micromol/l) or transplanted children.
- Elevated homocyst(e)ine levels correlated positively with age and negatively with estimated GFR and serum folate levels.
Conclusions:
- Hyperhomocyst(e)inaemia is a common feature in children with chronic renal failure, mirroring adult findings.
- Elevated homocyst(e)ine levels are detectable early in pediatric chronic renal failure and persist post-transplantation.
- The long-term benefit of treating hyperhomocyst(e)inaemia to reduce future atherosclerosis risk in these children requires further investigation.
Background:
Hyperhomocyst(e)inaemia has been identified as a significant risk factor for the occurrence of atherosclerosis in adults with chronic renal failure. Because of its presumed direct toxic effect on the vascular wall, long-standing hyperhomocyst(e)inaemia in children with chronic renal failure might have an important influence on their risk of future development of atherosclerosis. Hitherto no data on hyperhomocyst(e)inaemia in children with renal failure have been published.
Methods:
We investigated 16 children with chronic renal failure on conservative management, 12 children on haemodialysis and 17 children with a renal transplant. Age-matched controls were used for comparison. Plasma homocyst(e)ine levels after an overnight fast were determined by HPLC. Glomerular filtration rate was estimated by the Schwartz formula.
Results:
Mean plasma homocyst(e)ine levels were 12.6 +/- 5.2 micromol/l in the conservatively managed group, 22.2 +/- 13.5 micromol/l in the haemodialysed group, 14.2 +/- 2.1 micromol/l in transplanted children with an estimated GFR > 60 ml/min/1.73 m2 and 17.5 +/- 5.1 micromol/l in transplanted children with a lower estimated GFR. In all groups homocyst(e)ine levels were significantly elevated as compared to controls. Homocyst(e)ine levels were significantly correlated with age and negatively correlated with estimated GFR and serum folate levels.
Conclusions:
Hyperhomocyst(e)inaemia is a feature of chronic renal failure in children as well as in adults. Elevated homocyst(e)ine levels can already be demonstrated in children with renal failure before end-stage renal disease has developed and persist after renal transplantation. Whether treatment of hyperhomocyst(e)inaemia in children with renal failure decreases the risk for future atherosclerosis remains to be proven.