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Increased serum level of total homocysteine in CAPD patients despite fish oil therapy
Insights
Serum total homocysteine (HC) is linked to vascular disease in continuous ambulatory peritoneal dialysis (CAPD) patients. Fish oil therapy did not improve lipid metabolism or peritoneal function, with elevated HC indicating disease progression.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Nutritional Science
Background:
- Serum total homocysteine (HC) is a known risk factor for vascular disease and endothelial damage.
- Continuous ambulatory peritoneal dialysis (CAPD) patients exhibit an increased incidence of vascular disease.
- Disturbances in lipid metabolism are implicated in the promotion of atherosclerosis.
Purpose of the Study:
- To investigate the correlation between serum HC concentration and atherosclerotic/inflammatory events in CAPD patients.
- To assess the efficacy of fish oil therapy in mitigating lipid metabolism disturbances that contribute to atherosclerosis in CAPD patients.
Main Methods:
- Observational study of 14 CAPD patients with impaired peritoneal clearance and lipid metabolism.
- Measurement of serum HC, lipid profiles, erythrocyte aggregation and deformability, dialysate-to-plasma creatinine (D/P) ratio, and soluble interleukin-2 receptor (sIL-2R).
- Seven patients received fish oil therapy for three months; data analyzed using regression analysis.
Main Results:
- All patients presented with elevated serum HC.
- Fish oil treatment showed an average increase in HC (+18%) and total cholesterol (+6.6%), and increased erythrocyte aggregation (+9%).
- Improvements observed included decreased D/P ratio (-7%), enhanced erythrocyte deformability (-8%), and normalization of sIL-2R.
Conclusions:
- Fish oil therapy did not improve lipid metabolism disturbances or peritoneal function in CAPD patients.
- Significant correlations were found between HC and lipid metabolism/hemorheology parameters.
- Elevated serum HC in CAPD patients is indicative of disease progression.
Abstract:
It has been shown that serum total homocysteine (HC) is a risk factor for vascular disease which characterizes endothelial damage. The incidence of vascular disease is increased in continuous ambulatory peritoneal dialysis (CAPD) patients. Our aim was to investigate: (1) whether concentration of HC correlates with atherosclerotic and inflammatory events, and (2) if fish oil therapy can retard the disturbance in lipid metabolism which promotes atherosclerosis. Fourteen patients with various degrees of impaired peritoneal clearance and lipid metabolism were observed. In all patients the serum HC was elevated. Seven patients were treated with fish oil for three months. The results indicate an average increase of HC (+18%), total cholesterol (+6.6%), aggregation of erythrocytes (+9%), and an average decrease of dialysate-to-plasma creatinine (D/P) ratio (-7%), deformability of erythrocytes (-8%), and normalization of elevated soluble interleukin-2 receptor (sIL-2R) values. Regression analysis of all data demonstrated a significant correlation between HC and parameters of lipid metabolism and hemorheology. There were no significant correlations between HC and peritoneal function and serum cytokine levels. We conclude that the treatment in CAPD patients with fish oil did not improve the lipid metabolism disturbances in atherosclerosis and peritoneal function. Elevated HC confirms the progression of the disease.