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Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients.
Transplantation 2001; 71(12):1748-51T

Abstract

BACKGROUND

High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18.

METHODS

This cross-sectional study was conducted during routine posttransplantation follow-up. Fasting tHcy levels, serum creatinine, and lipoprotein profile were measured in 38 clinically stable renal transplant recipients with different degrees of renal function. No patient was receiving B vitamin or folic acid supplementation. Estimated glomerular filtration rate (GFR) was assessed according to Schwartz's formula. All patients followed a triple-drug immunosuppressive regimen, with the exception of three patients (deflazacort and azathioprine). Forty-one apparently healthy subjects constituted the control group. tHcy levels were determined by fluorescence polarization immunoassay in an IMx analyzer.

RESULTS

Mean tHcy levels in transplant recipients were significantly higher than in controls (16.8+/-8.7 micromol/L and 9.5+/-2.3 micromol/L, respectively; P<0.01). A significant positive correlation between tHcy and serum creatinine levels was observed for both transplant recipients (rS=0.70, P<0.01) and controls (rS=0.54, P<0.01). In transplant recipients, tHcy correlated negatively with estimated GFR (rS=[minus]0.47, P<0.05). Fasting tHcy levels in excess of 14.6 micromol/L (>95th percentile in controls) were present in 19 (50%) patients; 14 of these patients had an estimated GFR<60 ml/min per 1.73 m2. When the renal transplant recipients were analyzed by renal function, mean tHcy was significantly higher in patients with an estimated GFR<60 ml/min per 1.73 m2 compared with patients with an estimated GFR> or =60 ml/min per 1.73 m2 (20.5+/-9.9 vs. 13.2+/-5.8 micromol/L, P<0.01). Both groups were significantly different from controls (P<0.01). No relationship was found between tHcy level and either cumulative cyclosporine or cumulative methylprednisone doses. No differences were observed in tHcy levels or lipoprotein profile between patients who were receiving deflazacort and those on methylprednisone.

CONCLUSIONS

Hyperhomocysteinemia in renal transplant recipients is a common condition. Testing for fasting tHcy level might be a useful tool to identify patients at increased risk for development of vascular disease.

Authors+Show Affiliations

Servicio de Nefrología Pediátrica, Unidad de Hipertensión Arterial del Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Argentina. Krmar@enk.ks.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11455253

Citation

Krmar, R T., et al. "Hyperhomocysteinemia in Stable Pediatric, Adolescents, and Young Adult Renal Transplant Recipients." Transplantation, vol. 71, no. 12, 2001, pp. 1748-51.
Krmar RT, Ferraris JR, Ramirez JA, et al. Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients. Transplantation. 2001;71(12):1748-51.
Krmar, R. T., Ferraris, J. R., Ramirez, J. A., Galarza, C. R., Waisman, G., Janson, J. J., ... Cámera, M. I. (2001). Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients. Transplantation, 71(12), pp. 1748-51.
Krmar RT, et al. Hyperhomocysteinemia in Stable Pediatric, Adolescents, and Young Adult Renal Transplant Recipients. Transplantation. 2001 Jun 27;71(12):1748-51. PubMed PMID: 11455253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients. AU - Krmar,R T, AU - Ferraris,J R, AU - Ramirez,J A, AU - Galarza,C R, AU - Waisman,G, AU - Janson,J J, AU - Llapur,C J, AU - Sorroche,P, AU - Legal,S, AU - Cámera,M I, PY - 2001/7/17/pubmed PY - 2001/8/10/medline PY - 2001/7/17/entrez SP - 1748 EP - 51 JF - Transplantation JO - Transplantation VL - 71 IS - 12 N2 - BACKGROUND: High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18. METHODS: This cross-sectional study was conducted during routine posttransplantation follow-up. Fasting tHcy levels, serum creatinine, and lipoprotein profile were measured in 38 clinically stable renal transplant recipients with different degrees of renal function. No patient was receiving B vitamin or folic acid supplementation. Estimated glomerular filtration rate (GFR) was assessed according to Schwartz's formula. All patients followed a triple-drug immunosuppressive regimen, with the exception of three patients (deflazacort and azathioprine). Forty-one apparently healthy subjects constituted the control group. tHcy levels were determined by fluorescence polarization immunoassay in an IMx analyzer. RESULTS: Mean tHcy levels in transplant recipients were significantly higher than in controls (16.8+/-8.7 micromol/L and 9.5+/-2.3 micromol/L, respectively; P<0.01). A significant positive correlation between tHcy and serum creatinine levels was observed for both transplant recipients (rS=0.70, P<0.01) and controls (rS=0.54, P<0.01). In transplant recipients, tHcy correlated negatively with estimated GFR (rS=[minus]0.47, P<0.05). Fasting tHcy levels in excess of 14.6 micromol/L (>95th percentile in controls) were present in 19 (50%) patients; 14 of these patients had an estimated GFR<60 ml/min per 1.73 m2. When the renal transplant recipients were analyzed by renal function, mean tHcy was significantly higher in patients with an estimated GFR<60 ml/min per 1.73 m2 compared with patients with an estimated GFR> or =60 ml/min per 1.73 m2 (20.5+/-9.9 vs. 13.2+/-5.8 micromol/L, P<0.01). Both groups were significantly different from controls (P<0.01). No relationship was found between tHcy level and either cumulative cyclosporine or cumulative methylprednisone doses. No differences were observed in tHcy levels or lipoprotein profile between patients who were receiving deflazacort and those on methylprednisone. CONCLUSIONS: Hyperhomocysteinemia in renal transplant recipients is a common condition. Testing for fasting tHcy level might be a useful tool to identify patients at increased risk for development of vascular disease. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/11455253/Hyperhomocysteinemia_in_stable_pediatric_adolescents_and_young_adult_renal_transplant_recipients_ L2 - http://Insights.ovid.com/pubmed?pmid=11455253 DB - PRIME DP - Unbound Medicine ER -