PREVALENCE, DETERMINANTS, AND CLINICAL-SIGNIFICANCE OF HYPERHOMOCYST(E)INAEMIA IN RENAL-TRANSPLANT RECIPIENTS

Background. Previous studies have demonstrated that hyperhomocyst(e)in aemia is present in patients with impaired renal function and is corre lated with cardiovascular disease. Because conflicting data are availa ble on the prevalence, determinants, and clinical significance of hype rhomocyst(e)inaemia in renal-transplant recipients, we conducted the l argest cross-sectional study on homocysteine determinants and clinical correlates in renal transplant recipients. Methods. Plasma homocyst(e )ine concentrations and factors known to influence homocysteine metabo lism were analysed in 224 renal transplant recipients. Atherosclerotic complications were evaluated with respect to plasma homocysteine conc entrations. Results. Mean plasma homocyst(e)ine was 21.3 +/- 9.7 mu mo l/l. After adjusting for age, gender, transplant duration, and creatin ine clearance, patients with and without cyclosporin A (CsA) had simil ar plasma homocyst(e)ine concentrations (16.9 +/- 5.9 mu mol/l in CsA( +) patients vs 16.3 +/- 5.2 mu mol/l in CsA(-) patients: P = 0.3). We found a significant inverse relationship between plasma homocyst(e)ine and folate concentrations in both CsA(+) (r = -0.243; P < 0.005) and CsA(-) (r = -0.396; P<0.05) patients. Patients with a past history of cardiovascular events had higher plasma homocyst(e)ine concentrations (25.2 +/- 11.7 mmol/l vs 20.5 +/- 8.9 mmol/l; P < 0.005). Conclusion. Homocyst(e)inaemia is closely related to renal function and folate con centration in renal transplant recipients. CsA does not seem to have d irect effects on homocysteine metabolism. Hyperhomocyst(e)inaemia is a ssociated with cardiovascular disease in renal-transplant recipients. Prospective placebo-controlled homocysteine-lowering therapy studies a re required in this patient category.