Therapy of Hyperhomocysteinemia in Chronic Kidney Disease
Section snippets
Hcy-Decreasing Strategies in CKD Patients
Folic acid therapy in CKD patients has been shown to reduce, albeit not to normalize, plasma total Hcy concentrations, particularly in dialysis patients.1 The relative resistance to folate action in CKD patients could explain why the correction of total Hcy concentrations generally remains partial.6 Indeed, routine minimal folic acid supplementation of less than 1 mg daily, in contrast to what usually is observed in the population at large, does not have any effect on plasma total Hcy
Hcy-Decreasing Strategies and CVD
The impact of Hcy-decreasing strategies on the risk for CVD in CKD patients has not yet been evaluated extensively. An acute decrease of total Hcy concentrations by N-acetylcysteine supplementation during the dialysis session has been shown to improve pulse pressure and endothelial function in hemodialysis patients.22 However, N-acetylcysteine may exert other effects (eg, via its antioxidant capacity), which could explain the endothelial actions independently of decreasing the total Hcy
References (35)
- et al.
Hyperhomocysteinemia in relation to plasma free amino acids, biomarkers of inflammation and mortality in patients with chronic kidney disease starting dialysis therapy
Am J Kidney Dis
(2004) - et al.
Clinical epidemiology of cardiovascular disease in chronic renal disease
Am J Kidney Dis
(1998) - et al.
Distribution of plasma folate forms in hemodialysis patients receiving high daily doses of L-folinic or folic acid
Kidney Int
(2002) - et al.
L-folinic acid versus folic acid for the treatment of hyperhomocysteinemia in hemodialysis patients
Kidney Int
(2001) - et al.
Efficacy of folinic versus folic acid for the correction of hyperhomocysteinemia in hemodialysis patients
Am J Kidney Dis
(2001) - et al.
Kinetic basis of hyperhomocysteinemia in patients with chronic renal failure
Kidney Int
(1997) - et al.
Is folate a promising agent in the prevention and treatment of cardiovascular disease in patients with renal failure?
Kidney Int
(2002) Potential strategies to normalize the levels of homocysteine in chronic renal failure patients
Kidney Int Suppl
(2003)- et al.
Betaine supplementation decreases post-methionine hyperhomocysteinemia in chronic renal failure
Kidney Int
(2002) - et al.
Hydroxocobalamin reduces hyperhomocysteinemia in end-stage renal disease
Metabolism
(2002)
Long-term reduction of plasma homocysteine levels by super-flux dialyzers in hemodialysis patients
Kidney Int
The effect of N-acetylcysteine on plasma total homocysteine levels in hemodialysisA randomized, controlled study
Am J Kidney Dis
Homocysteine metabolism in cardiovascular cells and tissuesImplications for hyperhomocysteinemia and cardiovascular disease
Adv Enzyme Regul
Homocysteine and methionine metabolism in ESRDA stable isotope study
Kidney Int
Hyperhomocysteinemia in renal transplant recipients
Am J Transplant
Importance of homocysteine, lipoprotein (a) and non-classical cardiovascular risk factors (fibrinogen and advanced glycation end-products) for atherogenesis in uraemic patients
Nephrol Dial Transplant
Homocysteine and risk of ischemic heart disease and strokeA meta-analysis
JAMA
Cited by (5)
Homocysteine and hydrogen sulfide in epigenetic, metabolic and microbiota related renovascular hypertension
2016, Pharmacological ResearchCitation Excerpt :In a recent review article, Perna and Ingrosso have creditably discussed this topic in more details with up-to-date information which are mostly based on clinical findings in patients with renal insufficiency [94]. Besides this, it has also been reported that the correction of multiple remethylation abnormalities with various other drugs in CKD patients, which are not related to folic acid supplementation, removes homocysteine from protein binding sites [97]. This information could add invaluable strategies to decrease homocysteine levels in CKD patients independent of folic acid remethylation-pathway.
Therapy of Hyperhomocysteinemia in Hemodialysis Patients: Effects of Folates and N-Acetylcysteine
2012, Journal of Renal NutritionHyperhomocysteinemia in Chronic Renal Failure: Alternative Therapeutic Strategies
2012, Journal of Renal NutritionAltered folate receptor 2 expression in uraemic patients on haemodialysis: Implications for folate resistance
2013, Nephrology Dialysis Transplantation