Increased Serum Level of Total Homocysteine in Capd Patients despite Fish Oil Therapy

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 (DIP) ratio (-7%), deformability of erythrocytes (-8%), and normalization of elevated soluble interleukin2 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.

Homocysteine, a risk factor for cardiovascular disease

“…Kidney plays a part in homocysteine metabolism [ 144]. The incidence of vascular disease is increased with continuous ambulatory peritoneal dialysis [145] and acute dialysis [146,147]. Patients with renal failure, end-stage renal disease and chronic uremia have hyperhomocysteinemia and are at risk for atherosclerosis [32,148,149].…”

Major determinants of hyperhomocysteinemia in peritoneal dialysis patients

“…The mean total homocysteine plasma level in hemodialysis patients homozygous for the (T/T) allele was 36.4 mol/ liter, which was 43% higher compared to total homocysteine concentrations of 25.4 mol/liter in patients without mutation and was 3.8 times higher than the mean value of 9.6 mol/liter in healthy non-carriers [10]. Thus far, the mechanisms underlying hyperhomocysteinemia in peritoneal dialysis patients have only been investigated either in small patient populations [3,[11][12][13][14][15] or in patient populations differing in dialysis procedure or ethnic origin [2,4,16].…”

Omega‐3 fatty acid supplementation and total homocysteine levels in end‐stage renal disease patients

“…5,[10][11][12][13][14] Database searches revealed only one other published study specifically looking at the effect of n-3 fatty acid supplementation on tHcy levels in an ESRD population. 17 Holdt et al studied the effect of 3 months of FO supplementation on tHcy levels in continuous ambulatory peritoneal dialysis patients. 17 While results of this study showed no effect of FO supplementation in the reduction of tHcy, its authors hypothesized that prolonged exposure to FO might control tHcy levels more effectively.…”

“…17 Holdt et al studied the effect of 3 months of FO supplementation on tHcy levels in continuous ambulatory peritoneal dialysis patients. 17 While results of this study showed no effect of FO supplementation in the reduction of tHcy, its authors hypothesized that prolonged exposure to FO might control tHcy levels more effectively. Therefore, the present study extended the FO supplementation protocol to 6 months.…”

“…Published findings regarding the relationship between FO supplementation and tHcy have been equivocal and appear to vary based on sample population, FO dosage and study duration 5,10–14 . Database searches revealed only one other published study specifically looking at the effect of n‐3 fatty acid supplementation on tHcy levels in an ESRD population 17 . Holdt et al .…”