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- Title
Hyperhomocysteinemia in children on renal replacement therapy.
- Authors
Feinstein, Sofia; Sela, Ben-Ami; Drukker, Alfred; Becker-Cohen, Rachel; Raveh, David; Gavendo, Slava; Frishberg, Yaacov
- Abstract
Hyperhomocysteinemia is an independent risk factor for the development of atherosclerosis in adult patients on dialysis or after kidney transplantation. There are few data on homocysteine (Hcy) concentrations in children under these circumstances. The aim of our study was to evaluate plasma Hcy levels and their determining factors in children on renal replacement therapy. In 29 children and adolescents on chronic dialysis therapy and in 34 children after renal transplantation (Tx) fasting total plasma Hcy, red blood cell (RBC) folate, and serum vitamin B[sub 12] levels were measured. The plasma Hcy levels were expressed as number of standard deviations (SD) from mean level in age- and gender-matched controls. In dialysis patients the mean plasma Hcy level was elevated (4.4±0.8 SDs), without significant difference between patients on hemodialysis or continuous cycling peritoneal dialysis. In the dialysis patients a negative correlation (r=–0.49) between plasma Hcy levels and RBC folate concentrations was found. Oral folate supplementation was given to 8 of 21 dialysis patients, resulting in high RBC folate levels (>800 µg/ml) and normalization of the plasma Hcy levels (0.4±0.5 SDs). In Tx patients the mean plasma Hcy level was 5.6±1.4 SDs. Multivariate regression analysis revealed that the main factor determining Hcy level after kidney Tx was creatinine clearance. Patients with normal kidney function had a mean Hcy concentration of 1.69±0.86 compared with 10.0±2.2 in children with decreased function. Folate and cyclosporine levels had less significant effects on Hcy concentrations. Seven patients who were evaluated while on dialysis and after a successful kidney Tx demonstrated a significant reduction in Hcy levels. Children and adolescents on dialysis therapy and with impaired renal function after renal Tx have significant hyperhomocysteinemia. Oral folate supplementation normalizes the increased plasma Hcy levels and should...
- Subjects
HOMOCYSTEINE; KIDNEY transplantation; JUVENILE diseases
- Publication
Pediatric Nephrology, 2002, Vol 17, Issue 7, p515
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-002-0901-7