Prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients

Ducloux, Didier; Ruedin, Christophe; Gibey, R; Vautrin, P; Bresson-Vautrin, Catherine; Rebibou, Jean-Michel; Chalopin, Jean-Marc

doi:10.1093/ndt/13.11.2890

Cited by 58 publications

(48 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31,33 After renal transplantation, as many as 29% of patients will have an increase in Hcy correlating with the degree of renal impairment and folate levels. [34][35][36][37] Immunosuppressive medications such as azathioprine, prednisone, and tacrolimas do not appear to affect Hcy in either cardiac or renal transplant patients. 33,38,39 Cyclosporin is associated with elevated Hcy in heart transplants, but the data in renal transplants are conflicting.…”

Section: Etiology Of Hyperhomocysteinemiamentioning

confidence: 99%

The association of homocysteine and coronary artery disease

Gauthier¹,

Keevil²,

McBride³

2003

Clinical Cardiology

View full text Add to dashboard Cite

Summary: Hyperhomocysteinemia has been associated with increased risk of atherosclerosis and myocardial infarction by a number of prospective case-control studies. A variety of genetic mutations, nutritional deficiencies, disease states, and drugs can elevate homocysteine concentrations. Treatment with folic acid with or without B-complex vitamins effectively lowers homocysteine levels. Whether therapy corresponds with decreased risk of coronary events is unknown, but may be promising. This article reviews the biochemistry of homocysteine metabolism, pathogeneisis, and etiology of hyperhomocysteinemia, along with its association with coronary artery disease, screening, and treatment.

show abstract

Section: Etiology Of Hyperhomocysteinemiamentioning

confidence: 99%

The association of homocysteine and coronary artery disease

Gauthier¹,

Keevil²,

McBride³

2003

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…8,10,12 A smaller literature in renal transplantation also points a substantial risk of hyperhomocysteinemia contributing to the increased risk of early cardiovascular disease. [17][18][19][20][21] Whereas small retrospective studies are often subject to various biases, prospective studies generally provide a more robust estimate of association. Data from prospective stud-ies among populations with primary and secondary cardiovascular risk have shown that tHcy concentrations are inversely related with survival.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies suggest as well that hyperhomocysteinemia is a cardiovascular risk factor in these recipients. [17][18][19][20][21][22] In the present study, we prospectively followed a cohort of 202 recipients for 5 years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival.…”

mentioning

confidence: 99%

Impact of Homocysteinemia on Long-Term Renal Transplant Survival

Fonseca

Martins

Queirós

et al. 2005

Transplantation Proceedings

View full text Add to dashboard Cite

Aim. We prospectively followed a cohort of 202 renal transplant recipients for 5 years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival. Methods. Cox proportional hazards regression analysis was used to identify independent predictors of all-cause mortality and graft loss. Results. Hyperhomocysteinemia (tHcy Ͼ15 mol/L) was present in 48.7% of the 202 patients, predominantly among men (55.8%) as opposed to women (37.1%). At the end of the follow-up period, 13 (6.4%) patients had died including 10 from cardiovascular disease, and 23 had (11.4%) had lost their grafts. Patient death with a functioning allograft was the most prevalent cause of graft loss (13 recipients). Levels of tHcy were higher among patients who died than among survivors (median 23.9 vs 14.3 mol/L; P ϭ .005). Median tHcy concentration was also higher among the patients who had lost their allografts than those who did not (median 19.0 vs 14.1 mol/L; P ϭ .001). In a Cox regression model including gender, serum creatinine concentration, transplant duration, traditional cardiovascular risk factors, and associated conditions, such as past cardiovascular disease, only tHcy concentration (ln) (HR ϭ 5.50; 95% CI, 1.56 to 19.36; P ϭ .008) and age at transplantation (HR ϭ 1.07; 95% CI, 1.02 to 1.13; P ϭ .01) were independent predictors of patient survival. After censoring data for patient death, tHcy concentration was not a risk factor for graft loss.Conclusions. This prospective study shows that tHcy concentration is a significant predictor of mortality, but not of graft loss, after censoring data for patient death.S HORT-AND LONG-TERM GRAFT and patient survivals after renal transplantation have improved considerably over the past three decades. However, life expectancy beyond 10 years is still considerably less than in the general population, mainly due to cardiovascular events. In fact, an accelerated form of atherosclerosis commonly occurs in these patients. Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients, accounting for approximately 40% of all deaths. 1,2 Classic cardiovascular risk factors (eg, dyslipidemia, hypertension, and diabetes) as well as nonmodifiable risk factors such as age, gender, and family history do not fully explain the cardiovascular disease. Among other predictors of atherosclerotic disease, attention has been drawn to the association between homocysteine and cardiovascular events. Clinical and epidemiological studies have shown that homocysteine measured in serum or plasma is a strong predictor of cardiovascular risk. 3,4 The results of early cross-sectional and case-control studies strongly support this hypothesis. 5,6 Prospective studies of patient populations known to be at high risk of cardiovascular events, including renal patients, consistently report strong associations between homocysteine and cardiovascular as well as all-cause mortality. [7][8][9][10][11][12][13][14][15][16] Elevated levels of fasting total ...

show abstract

“…1,2 Increased plasma total homocysteine (tHcy) is considered to be a new and independent risk factor for CVD in adults with normal or impaired renal function, including stable RTRs; but little information exists about this condition in the pediatric age group. [3][4][5][6][7][8][9][10] In the present study, we sought to: (1) analyze the distribution of fasting tHcy levels to estimate the prevalence of hyperhomocysteinemia in children adolescents bearing a kidney allograft; (2) examine the relation between tHcy levels and the vitamin cofactors (folic acid and vitamin B 12 ), renal function, immunosuppressive therapy, and other potential determinants; and (3) assess the association between hyperhomocysteinemia and conventional risk factors for CVD.…”

mentioning

confidence: 99%

“…6 Our results agree with other studies performed in adult and pediatric RTRs that show a higher prevalence of hyperhomocysteinemia after RT. [3][4][5][6][7][8][9] When compared with pediatric reference ranges for tHcy, 11 hyperhomocysteinemia was found in 68% of our pediatric RTRs, or 56% if we considered the threshold to be 15 mol/L.…”

mentioning

confidence: 99%