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Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study.
J Am Soc Nephrol 2000; 11(1):134-7JA

Abstract

Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardiovascular risk factors. The mean follow-up was 21.2 +/- 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 +/-9.5 micromol/L and median concentration was 19 micromol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 micromol/L). tHcy correlated negatively with folate concentration (r = -0.3; P < 0.01). tHcy was closely related to creatinine concentration (r = 0.54; P < 0.001). Cardiovascular disease events (CVE) including death were observed in 30 patients (14.5 %; 7.34 events per 1000 person-months of follow-up). Fasting tHcy values were higher in patients who experienced CVE (31.5 +/- 10.3 versus 17.8 +/- 7.5; P < 0.001). Cox regression analysis showed that tHcy was a risk factor for cardiovascular complications (relative risk [RR] 1.06; 95% confidence interval (95% CI), 1.04 to 1.09; P < 0.0001). This corresponds to an increase in RR for CVE of 6% per micromol/L increase in tHcy concentration. Age (RR 1.55; 95% CI, 1.09 to 2.19; P < 0.01) and creatinine concentration (RR 1.34; 95% CI, 1.08 to 1.66; P < 0.01) were also independent predictors for CVE. This study demonstrates that elevated fasting tHcy is an independent risk factor for the development of CVE in chronic stable renal transplant recipients. Randomized, placebo-controlled homocysteine studies of the effect of tHcy lowering on CVE rates are urgently required in this patient population.

Authors+Show Affiliations

Department of Nephrology and Renal Transplantation, Saint Jacques Hospital, Besançon, France. adjusy@wanadoo.fr

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10616849

Citation

Ducloux, D, et al. "Serum Total Homocysteine and Cardiovascular Disease Occurrence in Chronic, Stable Renal Transplant Recipients: a Prospective Study." Journal of the American Society of Nephrology : JASN, vol. 11, no. 1, 2000, pp. 134-7.
Ducloux D, Motte G, Challier B, et al. Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study. J Am Soc Nephrol. 2000;11(1):134-7.
Ducloux, D., Motte, G., Challier, B., Gibey, R., & Chalopin, J. M. (2000). Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study. Journal of the American Society of Nephrology : JASN, 11(1), pp. 134-7.
Ducloux D, et al. Serum Total Homocysteine and Cardiovascular Disease Occurrence in Chronic, Stable Renal Transplant Recipients: a Prospective Study. J Am Soc Nephrol. 2000;11(1):134-7. PubMed PMID: 10616849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum total homocysteine and cardiovascular disease occurrence in chronic, stable renal transplant recipients: a prospective study. AU - Ducloux,D, AU - Motte,G, AU - Challier,B, AU - Gibey,R, AU - Chalopin,J M, PY - 2000/1/5/pubmed PY - 2000/1/5/medline PY - 2000/1/5/entrez SP - 134 EP - 7 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 11 IS - 1 N2 - Renal transplant recipients have disproportionately high rates of arteriosclerotic outcomes, and recent studies provided controlled evidence that clinically stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia. Few studies suggest that hyperhomocysteinemia may be a cardiovascular risk factor in renal transplant recipients. In the study presented here, the association between atherosclerotic events and homocysteine concentrations was examined in 207 stable renal transplant recipients. The role of hyperhomocysteinemia was analyzed with respect to other known cardiovascular risk factors. The mean follow-up was 21.2 +/- 1.9 mo (range, 14 to 26). Mean total homocysteine (tHcy) was 21.1 +/-9.5 micromol/L and median concentration was 19 micromol/L. Seventy percent of patients (n = 153) were hyperhomocysteinemic (values >15 micromol/L). tHcy correlated negatively with folate concentration (r = -0.3; P < 0.01). tHcy was closely related to creatinine concentration (r = 0.54; P < 0.001). Cardiovascular disease events (CVE) including death were observed in 30 patients (14.5 %; 7.34 events per 1000 person-months of follow-up). Fasting tHcy values were higher in patients who experienced CVE (31.5 +/- 10.3 versus 17.8 +/- 7.5; P < 0.001). Cox regression analysis showed that tHcy was a risk factor for cardiovascular complications (relative risk [RR] 1.06; 95% confidence interval (95% CI), 1.04 to 1.09; P < 0.0001). This corresponds to an increase in RR for CVE of 6% per micromol/L increase in tHcy concentration. Age (RR 1.55; 95% CI, 1.09 to 2.19; P < 0.01) and creatinine concentration (RR 1.34; 95% CI, 1.08 to 1.66; P < 0.01) were also independent predictors for CVE. This study demonstrates that elevated fasting tHcy is an independent risk factor for the development of CVE in chronic stable renal transplant recipients. Randomized, placebo-controlled homocysteine studies of the effect of tHcy lowering on CVE rates are urgently required in this patient population. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/10616849/Serum_total_homocysteine_and_cardiovascular_disease_occurrence_in_chronic_stable_renal_transplant_recipients:_a_prospective_study_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=10616849 DB - PRIME DP - Unbound Medicine ER -