NDT Advance Access originally published online on February 20, 2006
Nephrology Dialysis Transplantation 2006 21(5):1161-1166; doi:10.1093/ndt/gfl044
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Editorial Comment
Why is homocysteine elevated in renal failure and what can be expected from homocysteine-lowering?
Department of Internal Medicine, Amphia Hospital, PO Box 9057, 4800 RL Breda, The Netherlands
Correspondence and offprint requests to: Coen van Guldener, Department of Internal Medicine, Amphia Hospital, PO Box 9057, 4800 RL Breda, The Netherlands. Email: cvguldener@amphia.nl
Keywords: folic acid; homocysteine; sulphur amino acids
| The first 150 words of the full text of this article appear below. |
Patients with chronic kidney disease, especially end-stage renal disease (ESRD), exhibit many abnormalities in protein and amino acid metabolism. One of these alterations involves an increased plasma concentration of the sulphur-containing amino acid homocysteine. Hyperhomocysteinaemia has attracted a lot of attention in renal patients, not only because of its close relationship with renal function, but also because it has been implicated as an independent cardiovascular risk factor in these patients [1–3], although some recent studies have found no significant or even an inverse association between plasma homocysteine level and cardiovascular events and mortality in ESRD patients [4–6]. These discordant findings may have been caused by strong confounders which are associated with low homocysteine levels and increased mortality, such as protein energy malnutrition and/or inflammation [7].
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Homocysteine and renal function |
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Plasma homocysteine is strongly correlated with (estimates of) glomerular filtration rate (GFR). Hyperhomocysteinaemia, defined as a plasma total homocysteine
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Renal homocysteine metabolism |
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Extrarenal homocysteine metabolism |
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Consequences of hyperhomocysteinaemia |
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Homocysteine-lowering treatment
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