Hyperhomocysteinemia in Chronic Renal Failure Patients: Relation to Nutritional Status and Cardiovascular Disease
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Mohamed E. Suliman
Abstract
A moderate increase in plasma total homocysteine (tHcy) is considered to be an independent risk factor for cardiovascular disease (CVD) in the general population. Almost all chronic renal failure (CRF) patients have plasma concentration of tHcy that is elevated 3 to 4 times above normal. The prevalence of CVD, diabetes mellitus, malnutrition and hypoalbuminemia is high in CRF patients. Previous investigations have focused on the role of vitamin status on plasma tHcy in CRF patients, but little information exists on the influence of nutritional status and hypoalbuminemia on plasma tHcy in CRF, although a substantial fraction of tHcy (>70%) is protein-bound, mainly to albumin. Our study in patients with end-stage renal disease showed that more than 90% of the patients had elevated plasma tHcy levels, which were higher in patients with normal nutritional status than in malnourished patients. Moreover, plasma tHcy was inversely correlated with subjective global nutritional assessment (high values denote malnutrition) and positively correlated with serum albumin and protein intake. Hence, it seems likely that serum-albumin is a strong determinant of plasma tHcy in CRF patients and this may contribute to the lower tHcy levels in malnourished patients. Patients with diabetes mellitus had lower serum-albumin and plasma tHcy than non-diabetic patients, irrespective whether they were malnourished or not. Patients with CVD had lower (although still elevated) plasma tHcy levels than those without CVD. An explanation may be that the prevalence of diabetes mellitus, malnutrition and hypoalbuminema, i.e. factors that decrease tHcy, was higher in patients with CVD, which may explain why they had less elevated values. Assuming that hyperhomocysteinemia carries an independent risk of CVD, this implies that almost all CRF patients are exposed to this risk. CRF patients with CVD had a higher prevalence of malnutrition, hypoalbuminemia and diabetes mellitus, which was associated with a lower plasma Hcy level. This may explain why plasma tHcy was lower (although still abnormally high) in patients with CVD than in patients without CVD. The lower tHcy levels in CVD patients do not contradict the assumption that hyperhomocysteinemia is a risk factor for CVD since almost all patients are exposed to this risk, and other factors might be present that confound the relationship between the absolute tHcy levels and CVD. Our findings imply that nutritional status and serum albumin, as well as the presence of diabetes mellitus, should be taken into consideration when evaluating tHcy as a risk factor for CVD in CRF patients.
Copyright © 2001 by Walter de Gruyter GmbH & Co. KG
Articles in the same Issue
- Historical Aspects and Perspectives in Homocysteine Research
- The Importance of Hyperhomocysteinemia as a Risk Factor for Diseases: An Overview
- Pre-analytical Conditions Affecting the Determination of the Plasma Homocysteine Concentration
- Total Plasma Homocysteine and Related Amino Acids in End-Stage Renal Disease (ESRD) Patients Measured by Gas Chromatography-Mass Spectrometry – Comparison with the Abbott IMx Homocysteine Assay and the HPLC Method
- Is Hyperhomocysteinemia due to the Oxidative Depletion of Folate rather than to Insufficient Dietary Intake?
- Hyperhomocysteinemia in Advanced Age
- Genetic Defects as Important Factors for Moderate Hyperhomocysteinemia
- Heterogeneity of the Association between Plasma Homocysteine and Atherothrombotic Disease: Insights from Studies of Vascular Structure and Function
- Hyperhomocysteinemia as a Risk Factor for Venous Thrombosis
- Hyperhomocysteinaemia in Patients with Peripheral Arterial Occlusive Disease
- Homocysteine, Vascular Dementia and Alzheimer's Disease
- Homocysteine in Cerebrovascular Disease: an Independent Risk Factor for Subcortical Vascular Encephalopathy
- Vascular Dysfunction in Hyperhomocyst(e)inemia. Implications for Atherothrombotic Disease
- Hyperhomocysteinemia in Chronic Renal Failure Patients: Relation to Nutritional Status and Cardiovascular Disease
- Homocysteine, Cystathionine, Methylmalonic Acid and B-Vitamins in Patients with Renal Disease
- Hyperhomocysteinemia Is Related to Residual Glomerular Filtration and Folate, but not to Methylenetetrahydrofolate-Reductase and Methionine Synthase Polymorphisms, in Supplemented End-Stage Renal Disease Patients Undergoing Hemodialysis
- Effect of Treatment of Hypothyroidism on the Plasma Concentrations of Neuroactive Steroids and Homocysteine
- Hyperhomocysteinaemia and Human Reproduction
- Homocysteine in Postmenopausal Women and the Importance of Hormone Replacement Therapy
- Does a Single Vitamin B-Supplementation Induce Functional Vitamin B-Deficiency?
- IFCC News – July 2001
Articles in the same Issue
- Historical Aspects and Perspectives in Homocysteine Research
- The Importance of Hyperhomocysteinemia as a Risk Factor for Diseases: An Overview
- Pre-analytical Conditions Affecting the Determination of the Plasma Homocysteine Concentration
- Total Plasma Homocysteine and Related Amino Acids in End-Stage Renal Disease (ESRD) Patients Measured by Gas Chromatography-Mass Spectrometry – Comparison with the Abbott IMx Homocysteine Assay and the HPLC Method
- Is Hyperhomocysteinemia due to the Oxidative Depletion of Folate rather than to Insufficient Dietary Intake?
- Hyperhomocysteinemia in Advanced Age
- Genetic Defects as Important Factors for Moderate Hyperhomocysteinemia
- Heterogeneity of the Association between Plasma Homocysteine and Atherothrombotic Disease: Insights from Studies of Vascular Structure and Function
- Hyperhomocysteinemia as a Risk Factor for Venous Thrombosis
- Hyperhomocysteinaemia in Patients with Peripheral Arterial Occlusive Disease
- Homocysteine, Vascular Dementia and Alzheimer's Disease
- Homocysteine in Cerebrovascular Disease: an Independent Risk Factor for Subcortical Vascular Encephalopathy
- Vascular Dysfunction in Hyperhomocyst(e)inemia. Implications for Atherothrombotic Disease
- Hyperhomocysteinemia in Chronic Renal Failure Patients: Relation to Nutritional Status and Cardiovascular Disease
- Homocysteine, Cystathionine, Methylmalonic Acid and B-Vitamins in Patients with Renal Disease
- Hyperhomocysteinemia Is Related to Residual Glomerular Filtration and Folate, but not to Methylenetetrahydrofolate-Reductase and Methionine Synthase Polymorphisms, in Supplemented End-Stage Renal Disease Patients Undergoing Hemodialysis
- Effect of Treatment of Hypothyroidism on the Plasma Concentrations of Neuroactive Steroids and Homocysteine
- Hyperhomocysteinaemia and Human Reproduction
- Homocysteine in Postmenopausal Women and the Importance of Hormone Replacement Therapy
- Does a Single Vitamin B-Supplementation Induce Functional Vitamin B-Deficiency?
- IFCC News – July 2001
