Plasma total homocysteine levels among patients undergoing nocturnal versus standard hemodialysis.
Mild hyperhomocysteinemia, a putative risk factor for arteriosclerotic outcomes, is seen in >85% of hemodialysis patients. Therapeutic strategies, including pharmacologic-dose B vitamin supplementation and "high-flux" or "super-flux" hemodialysis, have consistently failed to normalize total homocysteine (tHcy) levels in these patients. Predialysis plasma tHcy levels in 23 patients who were undergoing nocturnal hemodialysis (NHD) six or seven nights/wk were compared with those in 31 patients from the same Canadian dialysis unit who were undergoing chronic standard hemodialysis (SHD) (all <65 yr of age, undergoing thrice-weekly treatments). The SHD patients were similar to typical North American chronic hemodialysis patients with respect to B vitamin status and albumin, creatinine, and tHcy levels. Geometric mean tHcy levels for the NHD patients were significantly lower (12.7 versus 20.0 microM, P < 0.0001), as was the prevalence of mild-to-moderate hyperhomocysteinemia (>12 microM; NHD, 57%; SHD, 94%; P = 0.002). Analysis of covariance adjusted for plasma folate, vitamin B12, and pyridoxal 5'-phosphate levels, age, and gender confirmed that NHD was independently associated with 6.0 microM lower geometric mean tHcy levels (P = 0.001). It is concluded that tHcy levels are significantly lower among NHD patients, compared with SHD patients. Clinical trials will be necessary to confirm that NHD is effective in reducing tHcy levels among patients with dialysis-dependent end-stage renal disease.
Friedman
Allon N
AN
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
Bostom
Andrew G
AG
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
Levey
Andrew S
AS
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
Rosenberg
Irwin H
IH
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
Selhub
Jacob
J
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
Pierratos
Andreas
A
*Vitamin Metabolism and Aging, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island; and Humber River Regional Hospital, University of Toronto, Toronto, Canada.
D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D006435:Renal Dialysis / Q000379:methods*
D006710:Homocysteine