Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Publication:
Author Interview:Dr. Paula Chiarello

What is the meaning of homocysteine in patients on dialysis?
Silva de Almeida CC, Guerra DC, Vannucchi MT, Geleilete TJ, Vannucchi H, Chiarello PG.

Department of Internal Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
J Ren Nutr. 2011 Sep;21(5):394-400.

What are the main findings of the study?

The most important finding confirms that there may be some confusion about the meaning of hyperhomocysteinemia in dialysis patients, in contrast to what is most accepted and consolidated in the general population, and that the association between malnutrition and inflammation may be the great creator of this situation .

Were any of the findings unexpected?

We expected to find associations of homocysteine ??with other parameters, slightly different in the two groups of patients, when the cut by hypoalbuminemia was used, but it did not, possibly due to the limitations imposed by the small sample size.

What should clinicians and patients take away from this study?

Physicians should carefully monitor the nutritional status of their patients, using the various parameters available to it, considering that this association between subclinical malnutrition and underlying inflammation can cast suspicion on traditional markers of risk in this population, bringing confusion to the choice of tools most suitable for clinical monitoring of this group.

As for patients, we have sufficient scientific evidence that maintaining an adequate nutritional status, in addition to improve quality of life, can provide important points to ensure a good prognosis in treatment.

What recommendations do you have for nephrology health care providers as a result of your study?

Investment in research seeking to better define the effect of malnutrition, with or without inflammation, on markers traditionally used in hemodialysis, may contribute significantly to the monitoring of this patient, seeking to find the best treatment and a better quality of life for them.

OBJECTIVE:
To evaluate the determinants of total plasma homocysteine levels and their relations with nutritional parameters, inflammatory status, and traditional risk factors for cardiovascular disease in renal failure patients on dialysis treatment.
DESIGN:
The study was conducted on 70 clinically stable patients, 50 of them on hemodialysis (70% men; 55.3 ± 14.5 years) and 20 on peritoneal dialysis (50% men; 62 ± 13.7 years). Patients were analyzed in terms of biochemical parameters (serum lipids, creatinine, homocysteine [Hcy], creatine-kinase [Ck], folic acid, and vitamin B(12)), anthropometric data, markers of inflammatory status (tumor necrosis factor-alpha, C-reactive protein, interleukin-6), and adapted subjective global assessment.
RESULTS:
The total prevalence of hyperhomocysteinemia (>15 μmol/L) was 85.7%. Plasma folic acid and plasma vitamin B(12) were within the normal range. Multiple regression analysis (r(2) = 0.20) revealed that the determinants of total Hcy were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Hcy was positively correlated with albumin and creatinine and negatively correlated with total cholesterol, high density lipoprotein cholesterol, folic acid, and vitamin B(12).
CONCLUSIONS:
The determinants of total Hcy in the study sample were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Evidently, the small sample size might have had an effect on the statistical analyses and further studies are needed. However, Hcy in patients on dialysis treatment may not have the same effect as observed in the general population. In this respect, the association between malnutrition and inflammation may be a confounding factor in the determination of the true relationship between Hcy, nutritional status, and cardiovascular risk factors in this group.