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Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12 deficiency in end-stage renal disease patients.
Ann Clin Lab Sci. 2013 Summer; 43(3):243-9.AC

Abstract

BACKGROUND

Vitamin replacement, particularly B vitamins, remains an important concern in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. Serum markers such as methylmalonic acid (MMA) and holoTranscobalamin (holoTC) used to detect vitamin B12 deficiency are affected by impaired renal function which makes the interpretation of these biomarkers difficult in ESRD patients. We investigated the role renal failure has on MMA and holoTC concentrations and evaluated using MMA and/or holoTC to identify B12 deficient patients.

MATERIALS AND METHODS

We evaluated the utility of serum MMA and holoTC for its role in the detection of vitamin B12 deficiency in dialysis patients (n=17) by using the reduction of MMA concentrations as a marker of the response to vitamin B12 treatment (1 mg, intramuscular injections once per month for 3 months). Nerve conduction studies (NCS) were done before and after vitamin B12 treatments to evaluate for any alteration in peripheral sensorimotor nerve function within a subset of the cohort.

RESULTS

Receiver operating characteristic curves for detection of vitamin B12 deficiency in dialysis patients showed that serum MMA concentrations had the greatest predictive potential (area under the curve = 0.792, p = 0.043) with an optimal cutoff of 750 nmol/L. Dialysis patients (n=10) with pre-MMA > 750 nmol/L and pre-HoloTC < 260 pmol/L showed a significant response to the vitamin B12 treatment (a mean MMA reduction of 461 nmol/L after B12 supplementation; p = 0.006).

CONCLUSION

MMA is viable marker of B12 deficiency in ESRD patients. Holo TC has potential as a supplementary marker with MMA to predict the response of vitamin B12 supplementation. Future studies on MMA and B12 should be done to confirm these findings in larger cohorts and to identify individuals who may benefit from vitamin B12 supplementation.

Authors+Show Affiliations

VA Medical Center-San Diego, San Diego, CA 92161, USA. niqbal@ucsd.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23884217

Citation

Iqbal, Navaid, et al. "Serum Methylmalonic Acid and holotranscobalamin-II as Markers for Vitamin B12 Deficiency in End-stage Renal Disease Patients." Annals of Clinical and Laboratory Science, vol. 43, no. 3, 2013, pp. 243-9.
Iqbal N, Azar D, Yun YM, et al. Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12 deficiency in end-stage renal disease patients. Ann Clin Lab Sci. 2013;43(3):243-9.
Iqbal, N., Azar, D., Yun, Y. M., Ghausi, O., Ix, J., & Fitzgerald, R. L. (2013). Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12 deficiency in end-stage renal disease patients. Annals of Clinical and Laboratory Science, 43(3), 243-9.
Iqbal N, et al. Serum Methylmalonic Acid and holotranscobalamin-II as Markers for Vitamin B12 Deficiency in End-stage Renal Disease Patients. Ann Clin Lab Sci. 2013;43(3):243-9. PubMed PMID: 23884217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12 deficiency in end-stage renal disease patients. AU - Iqbal,Navaid, AU - Azar,David, AU - Yun,Yeo-Min, AU - Ghausi,Omar, AU - Ix,Joachim, AU - Fitzgerald,Robert L, PY - 2013/7/26/entrez PY - 2013/7/26/pubmed PY - 2013/11/13/medline KW - Methylmalonic acid KW - end-stage renal disease KW - holotranscobalamin KW - vitamin B12 SP - 243 EP - 9 JF - Annals of clinical and laboratory science JO - Ann Clin Lab Sci VL - 43 IS - 3 N2 - BACKGROUND: Vitamin replacement, particularly B vitamins, remains an important concern in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. Serum markers such as methylmalonic acid (MMA) and holoTranscobalamin (holoTC) used to detect vitamin B12 deficiency are affected by impaired renal function which makes the interpretation of these biomarkers difficult in ESRD patients. We investigated the role renal failure has on MMA and holoTC concentrations and evaluated using MMA and/or holoTC to identify B12 deficient patients. MATERIALS AND METHODS: We evaluated the utility of serum MMA and holoTC for its role in the detection of vitamin B12 deficiency in dialysis patients (n=17) by using the reduction of MMA concentrations as a marker of the response to vitamin B12 treatment (1 mg, intramuscular injections once per month for 3 months). Nerve conduction studies (NCS) were done before and after vitamin B12 treatments to evaluate for any alteration in peripheral sensorimotor nerve function within a subset of the cohort. RESULTS: Receiver operating characteristic curves for detection of vitamin B12 deficiency in dialysis patients showed that serum MMA concentrations had the greatest predictive potential (area under the curve = 0.792, p = 0.043) with an optimal cutoff of 750 nmol/L. Dialysis patients (n=10) with pre-MMA > 750 nmol/L and pre-HoloTC < 260 pmol/L showed a significant response to the vitamin B12 treatment (a mean MMA reduction of 461 nmol/L after B12 supplementation; p = 0.006). CONCLUSION: MMA is viable marker of B12 deficiency in ESRD patients. Holo TC has potential as a supplementary marker with MMA to predict the response of vitamin B12 supplementation. Future studies on MMA and B12 should be done to confirm these findings in larger cohorts and to identify individuals who may benefit from vitamin B12 supplementation. SN - 1550-8080 UR - https://www.unboundmedicine.com/medline/citation/23884217/Serum_methylmalonic_acid_and_holotranscobalamin_II_as_markers_for_vitamin_B12_deficiency_in_end_stage_renal_disease_patients_ DB - PRIME DP - Unbound Medicine ER -