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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #163470
Title: HOMOCYSTEINE, CYSTENINE, AND B VITAMINS AS PREDICTORS OF KIDNEY DISEASE PROGRESSION

Author
item SARNAK, MARK - TUFTS-NEMC
item WANG, SHIN-RU - CLEVELAND CLIN FOUNDATION
item BECK, GERALD - CLEVELAND CLIN FOUNDATION
item KUSEK, JOHN - NIH
item SELHUB, JACOB - TUFTS-HNRCA
item GREENE, TOM - CLEVELAND CLIN FOUNDATION
item LEVEY, ANDREW - TUFTS-NEMC

Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/30/2002
Publication Date: 11/1/2002
Citation: SARNAK, M.J., WANG, S., BECK, G.J., KUSEK, J.W., SELHUB, J., GREENE, T., LEVEY, A.S. HOMOCYSTEINE, CYSTENINE, AND B VITAMINS AS PREDICTORS OF KIDNEY DISEASE PROGRESSION. AMERICAN JOURNAL OF KIDNEY DISEASES. 2002;40(5):932-939.

Interpretive Summary: Kidney disease patients have a very high risk of developing arteriosclerosis and heart disease which coincides with the deterioration of kidney function. Kidney disease is also accompanied with high blood level of the amino acid homocysteine, which have been shown to be related to increased risk of cardiovascular disease. In this study we sought to determine if the progression of kidney deterioration, hence increased risk of cardiovascular disease, can be predicted by a high level of homocysteine or low levels of folic acid and vitamins B6 and B12 (which can lower homocysteine). Our finding did not show that elevated homocysteine levels predict the progression of kidney disease.

Technical Abstract: Pathological similarities between atherosclerosis and glomerulosclerosis suggest that risk factors for the two processes may be similar. Elevated total homocysteine (tHcy) levels and low B vitamin levels are risk factors for atherosclerosis, but have not been evaluated sufficiently as risk factors for the progression of kidney disease. METHODS: Frozen samples from the Modification of Diet in Renal Disease Study were assayed for serum tHcy, cysteine, pyridoxal 5-phosphate (PLP), folate, and vitamin B12 levels in 804 participants. These factors were evaluated in both continuous and categorical analyses as risk factors for glomerular filtration rate (GFR) decline by using univariate and multivariable analyses. At baseline, mean tHcy levels in study A (GFR, 25 to 55 mL/min/1.73 m2) and study B (GFR, 13 to 24 mL/min/1.73 m2) were 16.9 micromol/L (median, 15.6 micromol/L) and 23.0 micromol/L (median, 20.5 micromol/L), respectively. Mean follow-up was 2.2 years. Mean GFR declines were -4.35 and -3.65 mL/min/y in studies A and B, respectively. There was no significant association between change in GFR with baseline level of tHcy in univariate or multivariable analysis in study A or univariate or multivariable analysis in study B. Similarly, higher cysteine levels and lower B vitamin levels were not associated with faster rates of GFR decline in multivariable analysis in either study. Higher tHcy or cysteine levels and lower folate, PLP, and vitamin B12 levels are not independent risk factors for progression of nondiabetic kidney disease.