Homocysteine, nutritional status and insulin in renal transplant recipients.
BACKGROUND
Hyperhomocysteinemia is an independent risk factor for the development of cardiovascular conditions in chronic stable renal-transplant recipients (RTR). Major determinants of plasma total homocysteine (tHcy) in RTR are renal function and folate levels. The data dealing with the possible regulation of the tHcy metabolism by insulin and nutritional status is conflicting in non-transplant populations.


METHODS
We examined the relationship between tHcy, insulin and nutritional status in 103 chronic, stable RTR. Demographic, clinical, and biochemical parameters were assessed for each patient.


RESULTS
Mean tHcy was 19.7+/-9.2 micro mol/l (range 8.6-53). The tHcy was strongly related to creatinine clearance (r=0.55, P<0.0001). Fasting tHcy levels were negatively related to folate concentrations (r=-0.32, P=0.01). There was a positive relationship between tHcy and LDL-cholesterol (r=0.34, P=0.03) and a significant negative correlation between tHcy and insulin (r=-0.38, P=0.01). Fasting tHcy concentrations were significantly higher in the lower quartile of insulin concentration than in the upper quartile (27.7+/-12.7 vs 15.9+/-9.5, P=0.01). In multivariate analysis, tHcy was associated with serum creatinine (P=0.001), insulin (P=0.02) and folate concentration (P=0.03). Patients with the highest IGF-1 concentration had lower tHcy than patients with the lowest IGF-1 concentration (16.8+/-5.7 vs 23.3+/-11 micro mol/l, P=0.01).


CONCLUSIONS
We observed an inverse relationship between insulin and tHcy in chronic, stable RTR.
Ducloux
Didier
D
Service de Néphrologie et Transplantation Rénale, Hopital Saint Jacques, Besançon, France. didier.ducloux@libertysurf.fr
Motte
Gérard
G
Nguyen
Nhu Uyen
NU
Abdelfatah
Aboubakr
A
Gibey
Roger
R
Chalopin
Jean-Marc
JM
D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood*; D016030:Kidney Transplantation / Q000502:physiology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011732:Pyridoxal Phosphate / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D007166:Immunosuppressive Agents; D007328:Insulin; D008055:Lipids; D006710:Homocysteine; D011732:Pyridoxal Phosphate; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12