Evidence for enhanced transsulphuration (TS) as a mechanism underlying lower hyperhomocysteinemia in patients undergoing home nocturnal hemodialysis (HNHD)

Abstract

ObjectivesElevated plasma total homocysteine (tHcy) >12μmol/L, an independent risk factor for cardiovascular disease, is prevalent (>85%) in patients undergoing standard hemodialysis (SHD). The current study was conducted to determine if lower tHcy associated with longer, more frequent dialysis (HNHD) is a function of dialysate HCY losses and/or enhanced HCY metabolism through the TS pathway (cysteine (Cys) and sulphate production).MethodsA cross‐sectional study including patients (n=33) on SHD (4 h, 3 days/wk), in‐centre nocturnal hemodialysis (INHD) (6‐8 h, 3 nights/wk) and HNHD (6‐8 h, 5‐7 nights/wk). Blood and dialysate were collected during a mid‐week dialysis session.ConclusionsThese data suggest that increased dialysate removal of Hcy alone does not explain lower plasma tHcy in HNHD. Rather, increased clearance of sulfate and cysteine may allow increased TS in patients on HNHD. Supported by Kidney Foundation of Canada