Nephrol Dial Transplant (2003) 18: V71-V73
© 2003 European Renal Association-European Dialysis and Transplant Association
Obesity and hyperhomocysteinaemia after kidney transplantation
tollová1tefan Vítko21 Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Chair of Nephrology, Institute for Postgraduate Medical Education and 2 Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Obesity and hyperhomocysteinaemia are found very frequently after kidney transplantation (Tx). They may independently represent risk factors for development of atherosclerosis and chronic allograft nephropathy. In a prospective metabolic study, we monitored, over a period of 24 months, a total of 118 obese transplant patients [body mass index (BMI) ≥30 kg/m2] with hyperhomocysteinaemia. We compared the findings of a new therapeutic regimen at 1 year (start of the study) and 2 years after renal transplantation. Based on a Subjective Global Assessment Scoring Sheet, we started at the end of the first year with an individualized hypoenergic–hypolipidaemic diet (IHHD). Subsequently, after corticoid withdrawal, IHHD was supplemented regularly with orlistat at a dose of up to 3 x 120 mg/day, statins (pravastatin 10–40 mg), folic acid 5 mg/day and vitamin B6 50 mg/day, and followed-up for up to 2 years. All patients were on a regimen of cyclosporin A and mycophenolate mofetil. During the study period, there was a significant decrease in BMI (P < 0.025) and total homocysteine level (P < 0.001). Long-term therapy was associated with a significant decrease in serum leptin (P < 0.001) and lipid metabolism parameters (P < 0.01). The mean values of serum folate and vitamin B6 also increased significantly (P < 0.01); creatinine clearance, mean blood pressure, proteinuria, lipoprotein(a) and apolipoprotein E isoforms did not differ significantly. Based on our results, we assume that obesity and hyperhomocysteinaemia after renal transplantation can be treated effectively by modified immunosuppression (corticosteroid withdrawal), long-term diet (IHHD), folic acid and vitamin B6 supplementation, and drugs suppressing digestion or absorption to reduce atherosclerotic and chronic allograft nephrop-athy processes.
Keywords: atherosclerosis; hyperhomocysteinaemia; hyperlipidaemia; kidney transplantation; leptin; obesity
Correspondence and offprint requests to: Professor Vladimír Teplan, MD, DSc, Head, Department of Nephrology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague 4, Czech Republic. E-mail: vladimir.teplan{at}medicon.cz