Obesity and hyperhomocysteinaemia after kidney transplantation.
Obesity and hyperhomocysteinaemia are found very frequently after kidney transplantation (Tx). They may independently represent risk factors for development of atherosclerosis and chronic allograft nephropathy. In a prospective metabolic study, we monitored, over a period of 24 months, a total of 118 obese transplant patients [body mass index (BMI) > or =30 kg/m(2)] with hyperhomocysteinaemia. We compared the findings of a new therapeutic regimen at 1 year (start of the study) and 2 years after renal transplantation. Based on a Subjective Global Assessment Scoring Sheet, we started at the end of the first year with an individualized hypoenergic-hypolipidaemic diet (IHHD). Subsequently, after corticoid withdrawal, IHHD was supplemented regularly with orlistat at a dose of up to 3 x 120 mg/day, statins (pravastatin 10-40 mg), folic acid 5 mg/day and vitamin B6 50 mg/day, and followed-up for up to 2 years. All patients were on a regimen of cyclosporin A and mycophenolate mofetil. During the study period, there was a significant decrease in BMI (P < 0.025) and total homocysteine level (P < 0.001). Long-term therapy was associated with a significant decrease in serum leptin (P < 0.001) and lipid metabolism parameters (P < 0.01). The mean values of serum folate and vitamin B6 also increased significantly (P < 0.01); creatinine clearance, mean blood pressure, proteinuria, lipoprotein(a) and apolipoprotein E isoforms did not differ significantly. Based on our results, we assume that obesity and hyperhomocysteinaemia after renal transplantation can be treated effectively by modified immunosuppression (corticosteroid withdrawal), long-term diet (IHHD), folic acid and vitamin B6 supplementation, and drugs suppressing digestion or absorption to reduce atherosclerotic and chronic allograft nephrop-athy processes.
Teplan
Vladimír
V
Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Chair of Nephrology, Institute for Postgraduate Medical Education, Prague, Czech Republic. vladimir.teplan@medicon.cz
Schück
Otto
O
Stollová
Milena
M
Vítko
Stefan
S
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004035:Diet Therapy / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications; D017035:Pravastatin / Q000008:administration & dosage; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D025101:Vitamin B 6 / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D025101:Vitamin B 6; D005492:Folic Acid; D017035:Pravastatin