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Hyperhomocysteinemia in renal transplant recipients
Allon N Friedman1, Irwin H Rosenberg, Jacob Selhub
1Vitamin Metabolism and Aging, Tufts Jean Mayer USDA HNRCA, Boston, MA, USA. afriedman@hnrc.tufts.edu
Insights
Renal transplant recipients often have high homocysteine levels, a cardiovascular disease risk factor. Treating this condition with high-dose vitamins may reduce cardiovascular risks in this population.
Area of Science:
- Nephrology and Cardiology
- Biochemistry of Cardiovascular Risk Factors
Background:
- Renal transplantation is a curative procedure for end-stage renal disease.
- Increased renal allograft survival shifts focus to cardiovascular morbidity in renal transplant recipients (RTRs).
- Hyperhomocysteinemia is a novel cardiovascular disease (CVD) risk factor prevalent in RTRs.
Purpose of the Study:
- To investigate the prevalence, etiology, and treatment of hyperhomocysteinemia in RTRs.
- To explore the potential of reducing hyperhomocysteinemia to mitigate CVD outcomes in RTRs.
- To establish RTRs as a suitable model for studying the impact of homocysteine reduction on CVD.
Main Methods:
- Observational studies on homocysteine levels in RTRs.
- Analysis of factors influencing homocysteine, including renal function, B-vitamins, albumin, age, and genetics.
- Evaluation of treatment responses to varying B-vitamin doses in RTRs.
Main Results:
- RTRs exhibit a significantly increased prevalence of hyperhomocysteinemia due to impaired renal function.
- While resistant to standard doses, RTRs respond to supraphysiologic B-vitamin therapy for hyperhomocysteinemia.
- The etiology and treatment of hyperhomocysteinemia in RTRs mirror those in the broader chronic renal insufficiency population.
Conclusions:
- Hyperhomocysteinemia is a significant concern in RTRs, linked to cardiovascular disease risk.
- Supraphysiologic B-vitamin therapy shows promise for managing hyperhomocysteinemia in RTRs.
- RTRs serve as a valuable population for research into the cardiovascular benefits of lowering homocysteine.
Abstract:
Renal transplantation is a commonly performed curative procedure for end-stage renal disease. With the increase in renal allograft half-lives, attention is now being focused on cardiovascular morbidity and death in the renal transplant recipient (RTR) population. Among the more novel cardiovascular disease (CVD) risk factors for which this group is at risk is hyperhomocysteinemia. Hyperhomocysteinemia has been associated with an increased risk of CVD, although prospective randomized trials designed to prove causality are still ongoing. Since plasma total homocysteine levels are inversely related to renal function, RTRs have a greatly increased prevalence of hyperhomocysteinemia. Other determinants of homocysteine include B-vitamins, albumin, age, and genetic polymorphisms. Although RTRs are resistant to the typical B-vitamin doses used to correct hyperhomocysteinemia in the general population, they do respond to supraphysiologic dose therapy. In terms of prevalence, etiology, and treatment of hyperhomocysteinemia, RTRs are very similar to the much larger chronic renal insufficiency population. For this reason, RTRs have been chosen as an ideal study population in investigating the effect of reducing hyperhomocysteinemia on CVD outcomes.