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Increased plasma homocysteine concentration in patients with chronic renal failure
P Chauveau1, B Chadefaux, M Coudé
1Department of Nephrology, Necker Hospital, Paris, France.
Insights
Elevated homocysteine (Hcy) levels are common in chronic kidney disease patients, even in early stages. This hyperhomocysteinemia may increase the risk of arterial disease in individuals with kidney failure.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Moderate hyperhomocysteinemia is a known risk factor for premature occlusive arterial disease.
- Arterial disease is a frequent complication in patients with uremia.
- Chronic renal failure (CRF) may impact homocysteine metabolism.
Purpose of the Study:
- To prospectively determine fasting plasma total homocysteine (Hcy) concentrations in nondialyzed patients with CRF.
- To investigate the correlation between Hcy levels and the severity of renal impairment.
- To assess whether Hcy is associated with occlusive arterial disease in this population.
Main Methods:
- Prospective study involving 79 nondialyzed patients with CRF and 45 healthy controls.
- Fasting plasma total homocysteine (Hcy) concentrations were measured.
- Creatinine clearance (Ccr) was used to categorize renal function.
- Statistical analyses included linear regression and comparison between groups.
Main Results:
- Mean Hcy concentrations were significantly higher in CRF patients compared to controls (p < 0.01).
- Hcy levels increased progressively with declining Ccr (r = 0.40, p < 0.01).
- Male patients aged >= 50 with occlusive arterial disease had significantly higher Hcy levels than those without (p < 0.01).
Conclusions:
- Hyperhomocysteinemia is present from the early stages of chronic renal failure.
- Declining renal function is associated with increasing Hcy levels.
- Elevated Hcy may be a significant risk factor for premature arteriosclerosis in uremic patients.
Abstract:
Since moderate hyperhomocysteinemia is associated with premature occlusive arterial disease, a frequent complication in uremic patients, we prospectively determined fasting plasma concentration of total homocysteine (Hcy) in 79 nondialyzed patients (47 males) with chronic renal failure. None received folate supplementation. Mean (+/- SD) Hcy concentrations were 16.2 +/- 8.1, 23.3 +/- 14.7 and 29.5 +/- 14.4 mumol/l in patient groups with creatinine clearance (Ccr) of, respectively, 30-75, 10-30 and < 10 ml/min, and significantly higher (p < 0.01) than in 45 healthy controls (8.2 +/- 2.2 mumol/l). Linear regression analysis showed a significant negative correlation between Ccr and Hcy (r = 0.40, p < 0.01). Among 37 male patients aged > or = 50 years, Hcy was significantly higher in 15 who had clinical evidence of occlusive arterial disease than in 22 who did not (28.9 +/- 13.3 vs. 17.8 +/- 8.9 mumol/l, p < 0.01). We conclude that hyperhomocysteinemia is present from the early stage of chronic renal failure and may constitute a risk factor for premature arteriosclerosis in uremic patients.