Hyperhomocysteinemia in renal transplant patients: an independent factor of cardiovascular disease.
Hyperhomocysteinemia (Hcy) is an independent factor of cardiovascular disease, which is the main cause of morbidity and mortality both in uremic and kidney transplant patients. The aim of the study was to determine Hcy, plasminogen activator inhibitor (PAI-1) and lipoprotein (a) (Lp(a)) serum levels in 70 patients with a well functioning renal transplant. We also verified whether these levels were modified by a multivitamin therapy. The genetic polymorphism of the methylenetetrahydrofolate reductase (MTHFR) enzyme which plays a main role in Hcy metabolism, was studied as well. We found Hcy, PAI-1 and Lp(a) levels significantly elevated with respect to healthy control subjects. The thermolabile form of the MTHFR enzyme was linked to higher Hcy levels. After a short time on therapy with B6, B12 and folic acid vitamins, Hcy and PAI-1 decreased to normal levels. The authors conclude that high Hcy levels could be a relevant covariate for cardiovascular disease in transplant patients and they suggest that vitamin supplementation be recommended as a part of therapy.
Renal Unit, Careggi University Hospital, Florence, Italy. salvadorim@ao-careggi.toscana.it
E
E
Bertoni
R
R
Marcucci
M
M
Zanazzi
A
A
Rosati
T
T
Brunelli
S
S
Fedi
G
G
Pepe
L
L
Di Maria
F M
FM
Colonna
A
A
Lombardi
R
R
Abbate
M
M
Salvadori
D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology* / Q000517:prevention & control; D016030:Kidney Transplantation; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D008875:Middle Aged; D000587:Oxidoreductases Acting on CH-NH Group Donors / Q000235:genetics; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011110:Polymorphism, Genetic; D011736:Pyridoxine / Q000627:therapeutic use; D012307:Risk Factors; D014805:Vitamin B 12 / Q000627:therapeutic use
D017270:Lipoprotein(a); D017395:Plasminogen Activator Inhibitor 1; D005492:Folic Acid; D000587:Oxidoreductases Acting on CH-NH Group Donors; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D011736:Pyridoxine; D014805:Vitamin B 12