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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Homocysteine and the kidney

Coen van Guldener1

  • 1Department of Internal Medicine, Amphia Hospital, Breda and VU University Medical Center, Amsterdam, The Netherlands. c.vanguldener@vumc.nl

Current Drug Metabolism
|February 22, 2005
PubMed

Insights

Elevated homocysteine levels are common in chronic kidney disease, potentially increasing vascular risks. Current treatments with folic acid have not effectively normalized homocysteine or improved cardiovascular outcomes in dialysis patients.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Plasma homocysteine concentration is strongly linked to renal function indices.
  • Hyperhomocysteinemia is implicated in high vascular event rates among chronic renal failure patients.
  • The exact pathophysiology of hyperhomocysteinemia in renal failure remains unclear.

Purpose of the Study:

  • To investigate the relationship between homocysteine levels and renal function.
  • To explore the altered whole-body homocysteine metabolism in renal insufficiency.
  • To evaluate the efficacy of current treatments for hyperhomocysteinemia in renal failure patients.

Main Methods:

  • Analysis of plasma homocysteine concentration in relation to renal function.
  • Stable isotope studies in dialysis patients to assess homocysteine clearance and metabolism.
  • Review of prospective studies linking hyperhomocysteinemia to cardiovascular outcomes.
  • Evaluation of intervention studies using folic acid-containing regimens.

Main Results:

  • Stable isotope studies revealed decreased homocysteine clearance via transsulfuration and impaired remethylation/methionine transmethylation in dialysis patients.
  • Several prospective studies suggest a link between hyperhomocysteinemia and adverse cardiovascular outcomes in renal failure.
  • Folic acid-based treatments have not consistently normalized plasma homocysteine levels in renal insufficiency.

Conclusions:

  • Whole-body homocysteine metabolism appears altered in renal insufficiency.
  • Hyperhomocysteinemia is a significant concern in chronic kidney disease, associated with cardiovascular risks.
  • Current therapeutic strategies, including folic acid, have not proven effective in normalizing homocysteine or mitigating vascular risks in dialysis patients.

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