Tags

Type your tag names separated by a space and hit enter

Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins.
Kidney Int. 2005 Apr; 67(4):1539-46.KI

Abstract

BACKGROUND

Data are limited on the determinants of homocysteine (tHcy) and its relationship with nutritional indices, and dietary protein intake, in the earlier stages of chronic kidney disease (CKD).

METHODS

Levels of tHcy were assayed at baseline (N= 804) and 1 year postrandomization (N= 678) in the Modification of Diet in Renal Disease (MDRD) Study [study A, glomerular filtration rate (GFR) 25 to 55 mL/min/1.73 m(2) and study B GFR 13 to 24 mL/min/1.73 m(2)]. Participants were randomly assigned to different blood pressure targets and protein diets and all subjects received a multivitamin supplement containing 1 mg of folic acid, 10 mg pyridoxal 5'-phosphate (PLP) and 6 mug of vitamin B(12). Multivariable analyses were used to evaluate determinants of tHcy at baseline and 1 year.

RESULTS

The prevalence of hyperhomocysteinemia (tHcy >15 mumol/L) at baseline was 56% in study A and 85% in study B. Baseline tHcy was negatively correlated with measures of body fat and dietary protein intake. Folate, vitamin B(12), and GFR were the major determinants of tHcy levels. Of the patients with hyperhomocysteinemia at baseline, 49% and 24% reduced their tHcy levels at 1 year to < or =15 micromol/L in study A and study B, respectively. There was no association between dietary protein intake and odds of developing hyperhomocysteinemia at 1 year in study A (P= 0.94) or study B (P= 0.10).

CONCLUSION

Hyperhomocysteinemia is partly amenable to correction by vitamin supplementation in CKD stages 3 and 4. There is insufficient evidence to suggest that low tHcy is associated with poor nutritional status in the MDRD Study cohort. B vitamins and GFR, but not dietary protein, are the major determinants of tHcy in this patient population.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15780109

Citation

Menon, Vandana, et al. "Homocysteine in Chronic Kidney Disease: Effect of Low Protein Diet and Repletion With B Vitamins." Kidney International, vol. 67, no. 4, 2005, pp. 1539-46.
Menon V, Wang X, Greene T, et al. Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins. Kidney Int. 2005;67(4):1539-46.
Menon, V., Wang, X., Greene, T., Beck, G. J., Kusek, J. W., Selhub, J., Levey, A. S., & Sarnak, M. J. (2005). Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins. Kidney International, 67(4), 1539-46.
Menon V, et al. Homocysteine in Chronic Kidney Disease: Effect of Low Protein Diet and Repletion With B Vitamins. Kidney Int. 2005;67(4):1539-46. PubMed PMID: 15780109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins. AU - Menon,Vandana, AU - Wang,Xuelei, AU - Greene,Tom, AU - Beck,Gerald J, AU - Kusek,John W, AU - Selhub,Jacob, AU - Levey,Andrew S, AU - Sarnak,Mark J, PY - 2005/3/23/pubmed PY - 2005/9/27/medline PY - 2005/3/23/entrez SP - 1539 EP - 46 JF - Kidney international JO - Kidney Int VL - 67 IS - 4 N2 - BACKGROUND: Data are limited on the determinants of homocysteine (tHcy) and its relationship with nutritional indices, and dietary protein intake, in the earlier stages of chronic kidney disease (CKD). METHODS: Levels of tHcy were assayed at baseline (N= 804) and 1 year postrandomization (N= 678) in the Modification of Diet in Renal Disease (MDRD) Study [study A, glomerular filtration rate (GFR) 25 to 55 mL/min/1.73 m(2) and study B GFR 13 to 24 mL/min/1.73 m(2)]. Participants were randomly assigned to different blood pressure targets and protein diets and all subjects received a multivitamin supplement containing 1 mg of folic acid, 10 mg pyridoxal 5'-phosphate (PLP) and 6 mug of vitamin B(12). Multivariable analyses were used to evaluate determinants of tHcy at baseline and 1 year. RESULTS: The prevalence of hyperhomocysteinemia (tHcy >15 mumol/L) at baseline was 56% in study A and 85% in study B. Baseline tHcy was negatively correlated with measures of body fat and dietary protein intake. Folate, vitamin B(12), and GFR were the major determinants of tHcy levels. Of the patients with hyperhomocysteinemia at baseline, 49% and 24% reduced their tHcy levels at 1 year to < or =15 micromol/L in study A and study B, respectively. There was no association between dietary protein intake and odds of developing hyperhomocysteinemia at 1 year in study A (P= 0.94) or study B (P= 0.10). CONCLUSION: Hyperhomocysteinemia is partly amenable to correction by vitamin supplementation in CKD stages 3 and 4. There is insufficient evidence to suggest that low tHcy is associated with poor nutritional status in the MDRD Study cohort. B vitamins and GFR, but not dietary protein, are the major determinants of tHcy in this patient population. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/15780109/Homocysteine_in_chronic_kidney_disease:_Effect_of_low_protein_diet_and_repletion_with_B_vitamins_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)50612-1 DB - PRIME DP - Unbound Medicine ER -