Nephrology Dialysis Transplantation, Vol 14, Issue 2 366-368, Copyright © 1999 by Oxford University Press
M Lilien, M Duran, K Van Hoeck, B Poll-The and C Schroder
Background: Hyperhomocyst(e)inaemia has been
identified as a significant risk factor for the occurrence of
atherosclerosis in adults with chronic renal failure. Because of its
presumed direct toxic effect on the vascular wall, long-standing
hyperhomocyst(e)inaemia in children with chronic renal failure might have
an important influence on their risk of future development of
atherosclerosis. Hitherto no data on hyperhomocyst(e)inaemia in children
with renal failure have been published. Methods: We
investigated 16 children with chronic renal failure on conservative
management, 12 children on haemodialysis and 17 children with a renal
transplant. Age-matched controls were used for comparison.
Plasmahomocyst(e)ine levels after an overnight fast were determined by
HPLC. Glomerular filtration rate was estimated by the Schwartz formula.
Results: Mean plasma homocyst(e)ine levels were
12.6±5.2 &mgr;mol/l in the conservatively managed group,
22.2±13.5 &mgr;mol/l in the haemodialysed group,
15.2±2.1 &mgr;mol/l in transplanted children with an
estimated GFR>60 ml/min/1.73 m2 and
17.5±5.1 &mgr;mol/l in transplanted children with a lower
estimated GFR. In all groups homocyst(e)ine levels were significantly
elevated as compared to controls. Homocyst(e)ine levels were significantly
correlated with age and negatively correlated with estimated GFR and serum
folate levels. Conclusions: Hyperhomocyst(e)inaemia is
a feature of chronic renal failure in children as well as in adults.
Elevated homocyst(e)ine levels can already be demonstrated in children with
renal failure before end-stage renal disease has developed and persist
after renal transplantation. Whether treatment of hyperhomocyst(e)inaemia
in children with renal failure decreases the risk for future
atherosclerosis remains to be proven. Key words:
children; chronic renal failure; folate; haemodialysis; homocyst(e)ine;
renal transplant
ORIGINAL ARTICLES
Hyperhomocyst(e)inaemia in children with chronic renal failure
Pediatric Renal Centre and Laboratory for Metabolic Diseases, Wilhelimina Children's Hospital, PO Box 18009, 3501 CA Utrecht, The Netherlands; Corresponding author
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