title: Chronic renal transplantation: a model for the hyperhomocysteinemia of renal insufficiency.
abstract: Renal transplant recipients (RTR) are considered representative of patients with chronic renal insufficiency (CRI) in general with respect to both reduced, progressively declining renal function, and increased risk for cardiovascular disease (CVD). In accord with this argument, we hypothesized that total (t) plasma concentrations of the putatively atherothrombotic amino acid homocysteine (Hcy) would be equivalent in RTR and CRI patients with comparable renal function. We determined plasma tHcy, folate, pyridoxal 5'-phosphate, and B12 concentrations, in addition to serum creatinine and albumin concentrations, in 86 chronic, stable RTR, and 238 patients with CRI. Within comparable ranges of serum creatinine (i.e. RTR=0.6-4.2 mg/dl; CRI=0.7-4.1 mg/dl), tHcy concentrations did not differ between the two groups (RTR=15.0 micromol/l; CRI=14.9 micromol/l, P=0.899). ANCOVA revealed that renal function, gauged as a simple creatinine measurement, was the major independent determinant of plasma tHcy concentrations, accounting for approximately 80-90% of the total variability in tHcy predicted by the full model (i.e. full model R(2)) containing, in addition to creatinine, the seven other potential explanatory variables. If controlled trials confirm that tHcy-lowering treatment reduces CVD events rates in RTR, these results should be applicable to CRI patients in general.
authors.affiliation: Division of General Internal Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA. abostom@loa.com
authors.forename: A G
authors.initials: AG
authors.lastname: Bostom
authors.forename: F
authors.initials: F
authors.lastname: Kronenberg
authors.forename: R Y
authors.initials: RY
authors.lastname: Gohh
authors.forename: V
authors.initials: V
authors.lastname: Schwenger
authors.forename: E
authors.initials: E
authors.lastname: Kuen
authors.forename: P
authors.initials: P
authors.lastname: König
authors.forename: G
authors.initials: G
authors.lastname: Kraatz
authors.forename: K
authors.initials: K
authors.lastname: Lhotta
authors.forename: J F
authors.initials: JF
authors.lastname: Mann
authors.forename: G A
authors.initials: GA
authors.lastname: Müller
authors.forename: U
authors.initials: U
authors.lastname: Neyer
authors.forename: W
authors.initials: W
authors.lastname: Riegel
authors.forename: P
authors.initials: P
authors.lastname: Riegler
authors.forename: E
authors.initials: E
authors.lastname: Ritz
authors.forename: J
authors.initials: J
authors.lastname: Selhub
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D003404:Creatinine