Homocysteine in Renal Transplant Recipients: Association with Transplant Duration and Renal Function

Homocysteine and diabetes: Role in macrovascular and microvascular complications

Diabetes mellitus (DM) can lead to the development of macro- and microvascular complications. Homocysteine (Hcy) may play a role in the development of cardiovascular (CV) diseases (CVDs). The role of Hcy in the development of the vascular complications associated with DM is not clearly defined. Despite a strong initial assumption regarding the importance of Hcy in DM and its complications, over time "enthusiasm has waned" because several studies showed unconvincing and occasionally contradictory results. A universal conclusion is not easy to draw given the diversity of studies (e.g. number of patients, design, folic acid and vitamin B status, ethnic differences, genetic background). For some complications, most results encourages further investigation. Impaired renal function is a major independent determinant of high total Hcy (tHcy) levels. However, the role of hyperhomocysteinaemia (HHcy) in the development of diabetic kidney disease (DKD) has yet to be determined. Hcy-lowering therapies can significantly decrease Hcy levels but their effects on CVD risk reduction are conflicting. Further studies are needed to determine the influence of Hcy-lowering therapy on CVD risk reduction, especially in patients with DM.

Oxidative Stress in Renal Transplant Patients Who Develop Cardiovascular Disease

Cardiovascular disease limits life expectancy of successful renal transplant patients. Reactive oxygen species have been implicated in the development of atherosclerosis, and high levels could be due to increased production or a decrease in antioxidant reserve. Cardiovascular disease in renal transplant recipients could be due to elevated levels of malondialdehyde (an index of levels of reactive oxygen species) and homocysteine and reduced levels of glutathione. Renal transplant recipients with and without cardiovascular disease were studied along with healthy controls. Serum malondialdehyde, plasma homocysteine, and red blood cell glutathione were measured. The results suggest that levels of serum malondialdehyde and plasma homocysteine were higher in patients with or without cardiovascular disease compared with controls; however, the values were similar in both groups of transplant patients. Glutathione levels in red blood cells were similar in all 3 groups. Renal transplant recipients without cardiovascular disease have high levels of oxidative stress and may develop cardiovascular disease with time.

Hyperhomocysteinemia after kidney transplantation

OBJECTIVE

To determine the prevalence of hyperhomocysteinemia (plasma homocysteine[Hcy] concentration≥15 μmol/L) and evaluate its correlation with allograft function.

MATERIALS AND METHODS

The study included 159 stable renal transplant recipients (104 men and 55 women). The prevalence and severity of hyperhomocysteinemia were compared in the transplant recipients vs 72 patients (48 men and 24 women) receiving hemodialysis therapy.

RESULTS

The mean (SD; range) fasting total Hcy concentration was higher in the hemodialysis group compared with the renal transplantation group: 27.4 (18.3; 10-95) μmol/L vs 16.6 (9.5; 4.5-45.0) μmol/L (P=.00). Hyperhomocysteinemia occurred more frequently in patients receiving hemodialysis therapy (74% vs 49%). No significant correlation was observed between Hcy concentration and recipient sex, cyclosporine trough concentration and concentration at 2 days after dosing, dyslipidemia,cytomegalovirus infection, diabetes mellitus, or aspartate or alanine aminotransferase concentration. Multivariate regression analysis revealed that serum creatinine concentration (P=.02) was the major determinant of increased total Hcy concentration in renal transplant recipients.

CONCLUSION

A high prevalence of moderate hyperhomocysteinemia was observed in renal transplant recipients. There was no correlation between graft function and Hcy concentration.

Factors associated with hyperhomocysteinemia after renal transplantation

Recent studies show that clinically stable renal transplant recipients have an increased prevalence of hyperhomocysteinemia (hyperHcy), but the mechanism of this disorder has not yet been elucidated. The aim of the present study was to evaluate the factors associated with hyperHcy after a successful renal transplantation. In 106 stable renal transplant recipients, total serum Hcy level (tHcy), folate, total protein, serum creatinine concentration, creatinine clearance, lipid status, body weight (BW), body mass index (BMI), and body fat (BF) were determined. The mean doses of cyclosporine, prednisolone, and azathioprine (mg/kg/day) were recorded. The mean serum tHcy level was significantly higher in renal transplant patients than in healthy controls (22.02 +/- 8.02 versus 13.0 +/- 3.3 micromol/ L; p < 0.001), and the incidence of patients with hyperHcy was 82%. Comparison of the group of 20 patients with tHcy level <15 micromol/L and the group of 86 patients with tHcy level >15 micromol/L revealed that the latter was significantly older, heavier, had been longer on dialysis before renal transplantation, and had older donors and poorer renal graft function. Significant correlation was found between tHcy level and recipient age, dialysis duration, BW, creatinine clearance, serum creatinine, and folate concentration. However, multivariate analysis indicated that creatinine clearance (p = 0.025) and BW (p = 0.03) were the only determinants of elevated total Hcy level in renal transplant recipients. HyperHcy persists after successful kidney transplantation in the majority of renal transplant recipients, and its appearance is primarily associated with creatinine clearance and body weight.