Creatine supplementation does not decrease total plasma homocysteine in chronic hemodialysis patients.
BACKGROUND
Hyperhomocysteinemia is present in the majority of chronic hemodialysis patients. Treatment with folic acid, vitamin B12, and vitamin B6 cannot fully normalize plasma homocysteine concentrations (tHcy). Previously we have demonstrated the tHcy-lowering effect of creatine supplementation in an animal model of uremia (Kidney Int 64:1331-1337, 2003). The present study investigates the effects of creatine supplementation on tHcy in a vitamin-repleted chronic hemodialysis population.


METHODS
Forty-five hemodialysis patients receiving folic acid and vitamin B6 and B12 were included. Patients were treated with creatine (2 g/day) or placebo during 2 treatment periods of 4 weeks, separated by a washout of 4 weeks. Plasma tHcy, creatine, Kt/V(urea), folic acid, vitamin B12, and routine biochemistry were determined, as well as the prognostic inflammatory and nutritional index.


RESULTS
All patients had elevated tHcy concentrations (21.2 +/- 5.6 micromol/L). Creatine treatment resulted in increased plasma and red blood cell creatine levels, documenting uptake of creatine. Creatine did not affect tHcy concentrations. There was no relationship between plasma creatine concentrations and tHcy concentrations. No changes in body weight, routine biochemistry, nutritional status, folic acid, or vitamin B12 were observed during the study.


CONCLUSIONS
Creatine supplementation at a rate of 2 g/day does not further decrease tHcy concentrations in chronic dialysis patients already treated with high dose folic acid, vitamin B6, and B12 supplementation.
Taes
Youri E C
YE
Laboratory Clinical Chemistry, University Hospital Ghent, Belgium. youri.taes@Ugent.be
Delanghe
Joris R
JR
De Bacquer
Dirk
D
Langlois
Michel
M
Stevens
Lut
L
Geerolf
Inge
I
Lameire
Norbert H
NH
De Vriese
An S
AS
D000368:Aged; D000369:Aged, 80 and over; D003401:Creatine / Q000008:administration & dosage* / Q000097:blood; D018592:Cross-Over Studies; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D006435:Renal Dialysis; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood; D025101:Vitamin B 6 / Q000008:administration & dosage / Q000097:blood
D006710:Homocysteine; D025101:Vitamin B 6; D005492:Folic Acid; D003401:Creatine; D014805:Vitamin B 12