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Plasma reduced homocysteine and other aminothiol concentrations in patients with CKD

Bodil Sjöberg1, Björn Anderstam, Mohamed Suliman

  • 1Division of Renal Medicine, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|December 27, 2005
PubMed

Insights

Reduced homocysteine (rHcy) and other aminothiols are elevated in kidney disease patients. Plasma rHcy may be a better cardiovascular risk marker than total Hcy in chronic kidney disease.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Hyperhomocysteinemia is a known cardiovascular disease risk factor, prevalent in chronic kidney disease (CKD) patients.
  • Reduced homocysteine (rHcy), characterized by an unbound -SH group, is identified as the primary atherogenic form of homocysteine (Hcy).
  • CKD impairs renal function, affecting the metabolism and clearance of Hcy and related aminothiols.

Purpose of the Study:

  • To investigate the relationship between different forms of Hcy (total Hcy [tHcy], free Hcy [fHcy], and rHcy) and other aminothiols.
  • To compare Hcy and aminothiol levels in hemodialysis (HD) patients, peritoneal dialysis (PD) patients, and non-dialyzed CKD patients against control subjects.
  • To assess the clinical relevance of rHcy as a marker for cardiovascular disease risk in CKD.

Main Methods:

  • Employed high-performance liquid chromatography (HPLC) to quantify rHcy, fHcy, tHcy, cysteine, cysteinyl-glycine, and glutathione.
  • Studied 19 HD patients, 12 PD patients, 47 non-dialyzed CKD patients, and 15 healthy control subjects.
  • Analyzed rHcy/tHcy ratios and changes in these levels during hemodialysis treatment.

Main Results:

  • PD and HD patients exhibited significantly higher tHcy levels (2.8 and 2.1 times, respectively) compared to controls.
  • Mean rHcy/tHcy ratios were significantly elevated in both HD and PD patients, indicating a higher proportion of the reduced, potentially atherogenic form.
  • A decrease in rHcy during HD was less pronounced than for tHcy and fHcy, leading to an increased rHcy/tHcy ratio post-treatment.

Conclusions:

  • Plasma levels of rHcy and other aminothiols are substantially increased in individuals with impaired renal function.
  • Dialysis patients show a markedly elevated and more variable rHcy/tHcy ratio compared to non-dialyzed CKD patients and controls.
  • Plasma rHcy is proposed as a more pertinent biomarker for cardiovascular disease risk in CKD patients due to its association with endothelial dysfunction and atherogenesis.
Abstract

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