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Role of homocysteine in end-stage renal disease

Chia-Chao Wu1, Cai-Mei Zheng, Yuh-Feng Lin

  • 1Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.

Clinical Biochemistry
|June 12, 2012
PubMed

Insights

Homocysteine (Hcy) lowering therapy may reduce cardiovascular disease (CVD) risks in non-diabetic patients with end-stage renal disease (ESRD). Diabetic ESRD patients show resistance, potentially requiring higher vitamin doses or alternative treatments.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Biochemistry

Background:

  • Patients undergoing dialysis exhibit significantly higher mortality rates than the general population.
  • Elevated plasma homocysteine (Hcy) levels are common in dialysis patients and are linked to cardiovascular disease (CVD) prognosis.
  • The efficacy of homocysteine-lowering therapy in end-stage renal disease (ESRD) patients remains debated.

Purpose of the Study:

  • To systematically review the literature on homocysteine-lowering therapy in ESRD patients.
  • To explore potential therapeutic strategies for managing Hcy levels in ESRD.
  • To identify factors influencing treatment response and resistance.

Main Methods:

  • Systematic literature review of multiple databases (PubMed, MEDLINE, OVID).
  • Survey of potential therapeutic measures for Hcy reduction.
  • Analysis of factors affecting Hcy-lowering therapy outcomes.

Main Results:

  • Effective Hcy normalization may decrease CVD morbidity and mortality in non-diabetic ESRD patients.
  • Hyperglycemia associated with diabetes mellitus confers resistance to Hcy-lowering therapy in ESRD patients.
  • Folic acid fortification may diminish beneficial effects; supraphysiological vitamin doses may be necessary for diabetic ESRD patients or those with high Hcy.

Conclusions:

  • Hcy-lowering therapy shows promise for non-diabetic ESRD patients, reducing CVD risks.
  • Diabetic ESRD patients exhibit treatment resistance, necessitating tailored therapeutic approaches.
  • Individual patient factors (sex, genotype, nutrition, fortification) influence treatment response to Hcy-lowering interventions.

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