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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #170076
Title: HOMOCYSTEINE IN CHRONIC KIDNEY DISEASE: EFFECT OF LOW PROTEIN DIET AND REPLETION WITH B VITAMINS

Author
item MENON, VANDANA - TUFTS-NEW ENGLAND MED CTR
item WANG, XUELEI - CLEVELAND CLINIC FOUND
item GREENE, TOM - CLEVELAND CLINIC FOUND
item BECK, GERALD - CLEVELAND CLINIC FOUND
item KUSEK, JOHN - NIH
item SELHUB, JACOB - TUFTS/HNRCA
item LEVEY, ANDREW - TUFTS-NEW ENGLAND MED CTR
item SARNAK, MARK - TUFTS-NEW ENGLAND MED CTR

Submitted to: Kidney International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/9/2004
Publication Date: 4/1/2005
Citation: Menon, V., Wang, X., Greene, T., Beck, G.J., Kusek, J.W., Selhub, J., Levey, A.S., Sarnak, M.J. 2005. Homocysteine in chronic kidney disease: Effect of low protein diet and repletion with B vitamins. Kidney International. 67(4):1539-46.

Interpretive Summary: Homocysteine is an amino acid which plays important function in the body but becomes a risk factor for cardiovascular disease when its concentration in the blood is elevated. Patients with kidney disease have high levels of homocysteine in their blood. This study examines the levels of homocysteine and the potential causes of high blood homocysteine in patients with mild and more advanced kidney disease at baseline and one year later during which time these patients received a special diet. We found that homocysteine is higher in patients with more severe renal failure. It was also among those that had low blood levels of B vitamins. The diet was effective in the lowering of homocysteine levels. 49% of patients with milder renal disease and who had high homocysteine a year before had normal homocysteine. Among patients with more severe kidney disease the decline was 29%. This study suggest that proper diet could result in the lowering of homocysteine even among those with renal disease.

Technical Abstract: Hyperhomocysteinemia is prevalent in patients with kidney failure and is resistant to vitamin supplementation. Data are limited on the determinants of homocysteine (tHcy) in the earlier stages of chronic kidney disease (CKD). Levels of tHcy were assayed at baseline (n=804) and one year post-randomization (n=678) from participants of the Modification of Diet in Renal Disease (MDRD) Study (Study A- glomerular filtration rate (GFR) 25-55 ml/min/1.73m**2, and Study B-GFR 13-24 ml/min/1.73m**2). Participants received a multivitamin supplement and were randomly assigned to different blood pressure targets and protein diets. Multivariable analyses were used to evaluate determinants of tHcy at these time points and to study the effect of protein diet on tHcy levels. Prevalence of hyperhomocysteinemia (tHcy>15micromol/l) at baseline was 56% in Study A and 85% in Study B. There was a negative correlation between baseline tHcy and nutritional indices such as body mass index. Folate, B12, and GFR were the major determinants of baseline and one year tHcy levels. Of the patients with hyperhomocysteinemia at baseline, and with tHcy levels available at one year, 49% reduced their tHcy levels to the normal range in Study A and 24% in Study B. There was no association between dietary protein intake and odds of developing hyperhomocysteinemia at one year in either Study A (p=0.94) or B (p=0.10). Hyperhomocysteinemia is prevalent in patients with CKD Stage 3-4 and is partly amenable to correction by vitamin supplementation. B vitamins and GFR are major determinants of tHcy in this population. Low homocysteine is not a marker of poor nutritional status in the MDRD Study cohort and dietary protein intake does not appear to influence tHcy levels in this patient population.