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Dialysis adequacy and homocyst(e)ine concentrations in peritoneal dialysis patients
D Ducloux1, L Heuzé-Lecornu, R Gibey
1Department of Nephrology and Renal Transplantation, Saint Jacques Hospital, Besançon, France.
Insights
Peritoneal dialysis significantly reduces homocysteine (Hcy) levels in patients with end-stage renal disease. Higher dialysis adequacy correlates with greater Hcy reduction, potentially impacting arteriosclerotic outcomes.
Area of Science:
- Nephrology
- Cardiovascular Science
- Biochemistry
Background:
- Conflicting data exists regarding the influence of dialysis adequacy on homocysteine (Hcy) levels in peritoneal dialysis patients.
- Understanding determinants of hyperhomocysteinaemia is crucial for managing end-stage renal disease (ESRD).
Purpose of the Study:
- To determine the variation in Hcy levels before and after initiating continuous ambulatory peritoneal dialysis (CAPD).
- To analyze the relationship between Hcy variation, dialysis adequacy, and Hcy peritoneal clearance.
Main Methods:
- Studied 46 new CAPD patients, measuring Hcy at baseline, 1 month, and 6 months post-dialysis.
- Analyzed Hcy variation against dialysis adequacy parameters (creatinine clearance, Kt/V) and Hcy peritoneal clearance.
- Assessed arteriosclerotic complications and their correlation with Hcy levels.
Main Results:
- Hcy levels significantly decreased from 31.9+/-9 micromol/l pre-dialysis to 23.2+/-6.9 micromol/l at 1 month post-dialysis (P < 0.0005).
- The reduction in Hcy concentration was positively correlated with Hcy peritoneal clearance, creatinine clearance, and Kt/V.
- Higher Hcy concentrations were observed in patients with arteriosclerotic complications.
Conclusions:
- Peritoneal dialysis leads to a significant and sustained reduction in Hcy concentrations in ESRD patients.
- Dialysis adequacy is a key factor influencing the decrease in Hcy levels.
- Improved dialysis adequacy may mitigate arteriosclerotic risks by lowering Hcy.
Introduction:
Determinants of hyperhomocysteinaemia in peritoneal dialysis patients have been recently reported but there is still conflicting data on the influence of dialysis adequacy on homocysteine (Hcy).
Methods:
We studied 46 consecutive new continuous ambulatory peritoneal dialysis (CAPD) patients to determine the variation of Hcy before and 1 and 6 months after dialysis. The variation in Hcy was analysed with respect to dialysis adequacy, factors known to influence its metabolism, and Hcy peritoneal clearance.
Results:
Hcy was 31.9+/-9 micromol/l before dialysis. It was significantly higher before dialysis than 1 month after the onset of PD (31.9+/-9 micromol/l vs 23.2+/-6.9 micromol/l, P < 0.0005). Weekly PD Hcy clearance was 14.3+/-5.4 1. There was no relationship between pre-dialysis Hcy and 1 month post-dialysis Hcy (r=0.176, P=0.15). There was a strong relationship between PD Hcy clearance and both PD creatinine clearance (r=0.502, P<0.005) and Kt/V (r=0.42, P<0.005). There was no relationship between Hcy and PD creatinine clearance (r= -0.221, P=0.11). In contrast, the decrease in tHcy at 1 month was related to PD Hcy clearance (r=0.487, P<0.01), to PD creatinine clearance (r= 0.349, P<0.02) and to Kt/V (r=0.32, P<0.02). Multivariate analysis confirmed the relationship between the decrease in Hcy and dialysis adequacy. Eleven patients (24%) experienced arteriosclerotic complications. Fasting Hcy concentrations in this population were significantly higher before and 1 month-post-dialysis than in patients without cardiovascular complications.
Conclusions:
We observed a significant and prolonged reduction in Hcy concentrations by peritoneal dialysis in end-stage renal disease patients. The decrease in Hcy concentration was positively related to dialysis adequacy. This study suggests the possibility that dialysis adequacy may influence arteriosclerotic outcomes through an Hcy-lowering effect.