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Peritoneal elimination of homocysteine moieties in continuous ambulatory peritoneal dialysis patients
A Vychytil1, M Födinger, M Papagiannopoulos
1Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Vienna, Austria.
Insights
Peritoneal dialysis does not efficiently remove total homocysteine in patients with elevated plasma levels. The amount eliminated is mainly influenced by plasma homocysteine concentration and dialysis parameters.
Area of Science:
- Nephrology
- Clinical Chemistry
Background:
- The elimination of total homocysteine via peritoneal dialysis is not well understood.
- The relationship between homocysteine transport and peritoneal dialysis characteristics is unknown.
Purpose of the Study:
- To investigate the factors influencing daily peritoneal excretion of total homocysteine in continuous ambulatory peritoneal dialysis (CAPD) patients.
- To analyze the relationship between peritoneal transport markers and homocysteine elimination.
Main Methods:
- Studied 39 CAPD patients, measuring plasma homocysteine, folate, vitamin B12, albumin, and various dialysis parameters.
- Analyzed the correlation between dialysate to plasma (D/P) creatinine and D/P homocysteine fractions in 25 patients.
Main Results:
- Plasma total homocysteine concentration, dialysate effluent volume, and D/P creatinine significantly influenced homocysteine elimination.
- Daily peritoneal excretion of total homocysteine was 38.94 ± 20.82 µmol.
- Strong positive linear associations were found between plasma homocysteine and elimination, and between D/P creatinine and D/P homocysteine fractions.
Conclusions:
- Peritoneal elimination of total homocysteine is primarily driven by plasma homocysteine levels.
- Peritoneal dialysis is not an effective method for reducing elevated total homocysteine in CAPD patients.
Background:
The amount of total homocysteine eliminated by peritoneal dialysis and its relationship to peritoneal transport characteristics in continuous ambulatory peritoneal dialysis (CAPD) patients are unknown.
Methods:
The influence of total homocysteine, folate, and vitamin B12 plasma concentrations, serum albumin levels, age, sex, dialysate to plasma ratio (D/P) creatinine, D/D0 glucose, D/P albumin, dialysate effluent volume, and effluent albumin on the daily peritoneal excretion of total homocysteine was investigated in 39 CAPD patients. The relationship of D/P creatinine to D/P total homocysteine, D/P free homocysteine, and D/P protein-bound homocysteine was analyzed additionally in a subgroup of 25 patients.
Results:
We observed a significant influence of plasma total homocysteine concentrations (P = 0.0001) of the daily dialysate effluent volume (P = 0.0221) and of the D/P creatinine (P = 0.0132) on peritoneal elimination of total homocysteine. The daily peritoneal excretion of total homocysteine was 38.94 +/- 20.82 mumol (5.27 +/- 2.81 mg). There was a positive linear association of the daily total homocysteine elimination with plasma total homocysteine concentrations (P = 0.0001). A significant linear correlation was observed between D/P creatinine and D/P total homocysteine (P = 0.0001), D/P free homocysteine (P = 0.0001), as well as D/P protein-bound homocysteine (P = 0.0001).
Conclusions:
The peritoneal elimination of total homocysteine primarily depends on the plasma total homocysteine concentration. Elevated total homocysteine plasma levels cannot be reduced efficiently by peritoneal dialysis.