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Homocysteine and renal disease.
Semin Thromb Hemost 2000; 26(3):313-24ST

Abstract

Hyperhomocysteinemia refers to an elevated circulating level of the sulfur-containing amino acid homocysteine and has been shown to be a risk factor for vascular disease in the general population. In patients with renal failure, hyperhomocysteinemia is a common feature. The underlying pathophysiological mechanism for this phenomenon is unknown. Proposed mechanisms include reduced renal elimination of homocysteine and impaired nonrenal disposal, possibly because of inhibition of crucial enzymes in the methionine-homocysteine metabolism by the uremic milieu. Absolute or relative deficiencies of folate, vitamin B6, or vitamin B12 may also play a role. Several case-control and prospective studies have now indicated that hyperhomocystenemia is an independent risk factor for atherothrombotic disease in patients with predialysis and end-stage renal disease. In renal patients, plasma homocysteine concentration can be reduced by administration of folic acid in doses ranging from 1 to 15 mg per day. In more than 50% of the cases, however, the homocysteine concentration remains above 15 micromol/L. The effects of vitamin B12 or vitamin B6 are unclear. Large intervention trials are now needed to establish whether homocysteine-lowering therapy will reduce atherothrombotic events in patients with renal failure. These studies are now planned or are ongoing.

Authors+Show Affiliations

Department of Internal Medicine, University Hospital and Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11011849

Citation

van Guldener, C, and K Robinson. "Homocysteine and Renal Disease." Seminars in Thrombosis and Hemostasis, vol. 26, no. 3, 2000, pp. 313-24.
van Guldener C, Robinson K. Homocysteine and renal disease. Semin Thromb Hemost. 2000;26(3):313-24.
van Guldener, C., & Robinson, K. (2000). Homocysteine and renal disease. Seminars in Thrombosis and Hemostasis, 26(3), pp. 313-24.
van Guldener C, Robinson K. Homocysteine and Renal Disease. Semin Thromb Hemost. 2000;26(3):313-24. PubMed PMID: 11011849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine and renal disease. AU - van Guldener,C, AU - Robinson,K, PY - 2000/9/30/pubmed PY - 2001/3/3/medline PY - 2000/9/30/entrez SP - 313 EP - 24 JF - Seminars in thrombosis and hemostasis JO - Semin. Thromb. Hemost. VL - 26 IS - 3 N2 - Hyperhomocysteinemia refers to an elevated circulating level of the sulfur-containing amino acid homocysteine and has been shown to be a risk factor for vascular disease in the general population. In patients with renal failure, hyperhomocysteinemia is a common feature. The underlying pathophysiological mechanism for this phenomenon is unknown. Proposed mechanisms include reduced renal elimination of homocysteine and impaired nonrenal disposal, possibly because of inhibition of crucial enzymes in the methionine-homocysteine metabolism by the uremic milieu. Absolute or relative deficiencies of folate, vitamin B6, or vitamin B12 may also play a role. Several case-control and prospective studies have now indicated that hyperhomocystenemia is an independent risk factor for atherothrombotic disease in patients with predialysis and end-stage renal disease. In renal patients, plasma homocysteine concentration can be reduced by administration of folic acid in doses ranging from 1 to 15 mg per day. In more than 50% of the cases, however, the homocysteine concentration remains above 15 micromol/L. The effects of vitamin B12 or vitamin B6 are unclear. Large intervention trials are now needed to establish whether homocysteine-lowering therapy will reduce atherothrombotic events in patients with renal failure. These studies are now planned or are ongoing. SN - 0094-6176 UR - https://www.unboundmedicine.com/medline/citation/11011849/Homocysteine_and_renal_disease_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2000-8407 DB - PRIME DP - Unbound Medicine ER -