Hyperhomocysteinemia in Renal Transplant Recipients

Abstract

Renal transplantation is a commonly performed curative procedure for end-stage renal disease. With the increase in renal allograft half-lives, attention is now being focused on cardiovascular morbidity and death in the renal transplant recipient (RTR) population. Among the more novel cardiovascular disease (CVD) risk factors for which this group is at risk is hyperhomocysteinemia. Hyperhomocysteinemia has been associated with an increased risk of CVD, although prospective randomized trials designed to prove causality are still ongoing. Since plasma total homocysteine levels are inversely related to renal function, RTRs have a greatly increased prevalence of hyperhomocysteinemia. Other determinants of homocysteine include B-vitamins, albumin, age, and genetic polymorphisms. Although RTRs are resistant to the typical B-vitamin doses used to correct hyperhomocysteinemia in the general population, they do respond to supraphysiologic dose therapy. In terms of prevalence, etiology, and treatment of hyperhomocysteinemia, RTRs are very similar to the much larger chronic renal insufficiency population. For this reason, RTRs have been chosen as an ideal study population in investigating the effect of reducing hyperhomocysteinemia on CVD outcomes.

Plasma homocysteine and total antioxidant status in diabetic chronic kidney disease and diabetic renal allograft recipients: effect of folic acid therapy

“…10,11,12 The observation of hyperhomocysteinemia in about half of our diabetic renal transplant recipients has also been reported by others. 13,14 Folic acid has been shown to lower homocysteine levels in several studies. 8,15,16 We did not observe any significant difference in the values of total antioxidant status in diabetics with end stage kidney disease, uncomplicated diabetes mellitus, stable renal allograft recipients and healthy individuals.…”

Cardiovascular Effects of Growth Hormone in Adult Hemodialysis Patients: Results from a Randomized Controlled Trial

“…In patients with CKD, there is an inverse relationship between plasma homocysteine and renal function, with the highest levels in patients requiring dialysis [43]. Some observational cohort studies have suggested that homocysteine levels might represent an independent risk factor for CVD in this population [44,45,46,47].…”

Ischemia/Reperfusion Reduces Transcription Factor Sp1-mediated Cystathionine β-Synthase Expression in the Kidney

“…Ischemia/reperfusion injury is a result of decreased blood flow to the tissue followed by restoration of blood flow to the ischemic area. Hyperhomocysteinemia is a common clinical finding in patients with chronic kidney disease or acute renal failure (24). We have investigated the role of CBS in Hcy and H 2 S metabolism in a rat model with kidney ischemia/reperfusion (16,25,26).…”