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Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly.
J Intern Med 2007; 261(1):65-73JI

Abstract

OBJECTIVES

To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population.

DESIGN AND SETTING

Population-based study of 209 community-dwelling subjects, mean age 76 years.

INTERVENTIONS

Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo.

MAIN OUTCOME MEASURES

Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex.

RESULTS

Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%).

CONCLUSIONS

The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented.

Authors+Show Affiliations

Department of Medicine, Salhgrenska Academy at Göteborg University, Göteborg, Sweden. catharina.lewerin@vgregion.seNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17222169

Citation

Lewerin, C, et al. "Glomerular Filtration Rate as Measured By Serum Cystatin C Is an Important Determinant of Plasma Homocysteine and Serum Methylmalonic Acid in the Elderly." Journal of Internal Medicine, vol. 261, no. 1, 2007, pp. 65-73.
Lewerin C, Ljungman S, Nilsson-Ehle H. Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly. J Intern Med. 2007;261(1):65-73.
Lewerin, C., Ljungman, S., & Nilsson-Ehle, H. (2007). Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly. Journal of Internal Medicine, 261(1), pp. 65-73.
Lewerin C, Ljungman S, Nilsson-Ehle H. Glomerular Filtration Rate as Measured By Serum Cystatin C Is an Important Determinant of Plasma Homocysteine and Serum Methylmalonic Acid in the Elderly. J Intern Med. 2007;261(1):65-73. PubMed PMID: 17222169.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly. AU - Lewerin,C, AU - Ljungman,S, AU - Nilsson-Ehle,H, PY - 2007/1/16/pubmed PY - 2007/2/21/medline PY - 2007/1/16/entrez SP - 65 EP - 73 JF - Journal of internal medicine JO - J. Intern. Med. VL - 261 IS - 1 N2 - OBJECTIVES: To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population. DESIGN AND SETTING: Population-based study of 209 community-dwelling subjects, mean age 76 years. INTERVENTIONS: Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo. MAIN OUTCOME MEASURES: Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex. RESULTS: Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%). CONCLUSIONS: The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented. SN - 0954-6820 UR - https://www.unboundmedicine.com/medline/citation/17222169/Glomerular_filtration_rate_as_measured_by_serum_cystatin_C_is_an_important_determinant_of_plasma_homocysteine_and_serum_methylmalonic_acid_in_the_elderly_ L2 - https://doi.org/10.1111/j.1365-2796.2006.01732.x DB - PRIME DP - Unbound Medicine ER -