Nephrology Dialysis Transplantation, Vol 14, Issue 1 142-146, Copyright © 1999 by Oxford University Press
M Arnadottir, A Berg, J Hegbrant and B Hultberg
Background: The high prevalence of
hyperhomocysteinaemia in uraemic patients is of interest because of the
cardiovascular risk associated with increased plasma total homocysteine
(tHcy) concentration. Treatment with folic acid lowers tHcy in
haemodialysis patients, however, in most patients not to
normohomocysteinaemic levels. With possible tHcy-lowering modifications in
mind, we studied the influence of standard haemodialysis on tHcy.
Methods: In 56 folate-loaded haemodialysis patients,
tHcy and parameters of dialysis adequacy were measured. In six patients,
interdialytic curves of tHcy and serum creatinine concentrations were
obtained and in five patients, the amount of homocysteine (Hcy) in
dialysate were determined. Results: tHcy
(21.8±14.4 &mgr;mol/l) correlated significantly with Kt/
(r=0.32, P<0.05), total Kt/V (r=0.29, P<0.05), nPCR (r=0.30,
P<0.05) and serum concentrations of albumin (r=0.28, P<0.05)
and cobalamines (r=-0.27, P<0.05). In a multiple linear regression
analysis, only serum albumin concentrations significantly predicted tHcy
(r=0.34, P<0.05). During dialysis, tHcy decreased by 28% and
remained constant for at least 8 h after treatment. The amount of Hcy
recovered in dialysate was 63 &mgr;mol (12-158 &mgr;mol). There was
no difference in tHcy between those who had residual renal function and
those who had not. Conclusions: The direct
relationship between tHcy and Kt/V seemed to be mediated by the serum
albumin concentration. The shape of the interdialytic tHcy curve suggested
facilitated Hcy removal for at least 8 h after dialysis possibly due to
reduced levels of inhibitory activities against relevant enzyme(s). The
dialysed amount of Hcy did not seem to contribute significantly to Hcy
removal. Thus, modifications of standard dialytic regimens are not likely
to be effective from a tHcy-lowering point of view whereas convective
procedures such as haemofiltration or haemofiltration might be more
effective. Key words: haemodialysis; homocysteine;
renal failure
ORIGINAL ARTICLES
Influence of haemodialysis on plasma total homocystein concentration
Division of Nephrology, Department of Medicine, National University Hospital, Reykjavik, Iceland; Department of Nephrology and Department of Clinical Chemistry, University Hospital in Lund, Lund, Sweden; Park Dialys, Gambro Group Renal Care, Lund, Sweden; Corresponding author
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