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Prevalence and determinants of hyperhomocysteinemia in hemodialysis and peritoneal dialysis
A Moustapha1, A Gupta, K Robinson
1Department of Internal Medicine, Cleveland Clinic Foundation, Ohio, USA.
Insights
Hyperhomocysteinemia is more common in hemodialysis patients than peritoneal dialysis patients. Folate levels appear to influence homocysteine in hemodialysis but not peritoneal dialysis, suggesting different mechanisms.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Nutritional Biochemistry
Background:
- Hyperhomocysteinemia is a risk factor for atherosclerotic complications in end-stage renal disease.
- Key determinants include folate, vitamin B12, vitamin B6, and glomerular filtration rate.
Purpose of the Study:
- To compare plasma homocysteine levels and their determinants in patients undergoing hemodialysis (HD) versus peritoneal dialysis (PD).
- To investigate the relationship between homocysteine and nutritional factors in different dialysis modalities.
Main Methods:
- Measured plasma folate, vitamin B12, vitamin B6, and creatinine in 130 HD and 46 PD patients.
- Analyzed dialysis dose and duration.
- Used multiple logistic regression to identify independent determinants of total homocysteine.
Main Results:
- HD patients had significantly higher total homocysteine (29.8 vs 19.9 mumol/L) and hyperhomocysteinemia prevalence (90.8% vs 67.4%) compared to PD patients.
- HD patients had lower plasma folate levels (45.5 vs 104.2 nmol/L).
- Plasma folate was the sole determinant of homocysteine in HD patients (r = -0.31), while no correlation was found in PD patients.
Conclusions:
- Hyperhomocysteinemia is more prevalent and severe in HD patients than PD patients.
- The homocysteine response to folate supplementation may be impaired in PD patients.
Background:
Hyperhomocysteinemia is an independent risk factor for atherosclerotic complications in patients with end-stage renal disease, although the mechanisms remain unclear. The major determinants of plasma homocysteine concentration are usually folate, vitamin B12, pyridoxal 5'-phosphate (vitamin B6), and glomerular filtration rate.
Methods:
We measured factors, including plasma folate, vitamin B12, vitamin B6, creatinine, as well as the dose and duration of dialysis, that might affect plasma homocysteine concentrations in 130 patients on hemodialysis (HD) and compared these observations with those in 46 patients on peritoneal dialysis (PD). Independent determinants of total homocysteine were identified using a multiple logistical regression analysis.
Results:
Total homocysteine values averaged 29.8 mumol/liter in HD patients, significantly higher than the mean value of 19.9 mumol/liter observed in patients on PD (P < 0.001). The prevalence of hyperhomocysteinemia was 90.8% among HD patients, significantly higher than the prevalence of 67.4% among PD patients. Folate values in HD patients averaged 45.5 nmol/liter and were significantly lower than in PD patients (104.2 nmol/liter, P < 0.001). For patients on HD, the only determinant of total homocysteine concentration was plasma folate (r = -0.31, P < 0.001). In contrast, for PD patients, total homocysteine did not correlate with plasma folate, vitamin B12, or vitamin B6.
Conclusions:
Hyperhomocysteinemia is more prevalent and intense in HD patients compared with those on PD. The homocysteine response may become refractory to excess folate supplementation in PD patients.
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