title: Treatment of hyperhomocysteinemia after renal transplantation.
abstract: BACKGROUND
  Several epidemiologic prospective studies have provided strong evidence that hyperhomocysteinemia (HHC) is a risk factor for cardiovascular disease (CVD) due to its role in producing endothelial damage due to oxidation stress. Several studies show that combined folic acid (FA) and vitamin B12 (B12) treatment decreases fasting total homocysteine (HC) levels in renal transplant recipients (RTR). The aim of the study was to determine the efficacy and safety during one year of combined FA and B12 treatment in 89 RTR, as well as the relationship between HHC with other known risk factors for CVD and the intrinsic characteristics of the transplantation.
  
  
  METHODS
  Among 193 RTR in whom we determined the baseline levels of HC, FA, B12, creatinine, and CV risk factors, 81 had normal (HC < 14 micromol/L) and 112 elevated (HC > or = 14 micromol/L) HC levels, 89 of whom were included in a treatment group (23 nontreated). Analytic measures were performed at baseline and 1, 3, and 12 months.
  
  
  RESULTS
  We observed a decrease in HC levels among the treatment group (P<.05) after 12 months without differences in the other groups. There were no differences in age, hypertension, hypercholesterolemia, smoking, presence of diabetes, or type of immunosuppression between the groups. There was a significant correlation between basal creatinine and HC level (P<.05). A higher prevalence of CVD was observed in the HHC group (P<.05).
  
  
  CONCLUSIONS
  HHC is associated with worse renal function and a higher prevalence of CVD. FA and B12 treatment normalize HC levels, representing a safe treatment that could improve the long-term vascular prognosis of RTR.
authors.affiliation: Renal Unit, Clinica Universitaria de Navarra, Pamplona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Manrique
authors.forename: P
authors.initials: P
authors.lastname: Errasti
authors.forename: J
authors.initials: J
authors.lastname: Lavilla
authors.forename: E
authors.initials: E
authors.lastname: Rossich
authors.forename: A
authors.initials: A
authors.lastname: Hernandez
authors.forename: D
authors.initials: D
authors.lastname: Pujante
authors.forename: N
authors.initials: N
authors.lastname: Garcia-Fernández
authors.forename: A
authors.initials: A
authors.lastname: Purroy
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005215:Fasting; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000188:drug therapy*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D015203:Reproducibility of Results; D012449:Safety; D013997:Time Factors; D014805:Vitamin B 12 / Q000627:therapeutic use*
chemical_list: D006710:Homocysteine; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12