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Determinants of hyperhomocysteinemia in healthy and hypertensive subjects: A population-based study and systematic review. Clin Nutr 2016; 36:1215-1230. [PMID: 27908565 DOI: 10.1016/j.clnu.2016.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/16/2016] [Accepted: 11/11/2016] [Indexed: 01/18/2023]
Abstract
AIMS Hyperhomocysteinemia (HHcy) is known to increase the risk of many diseases. Factors influencing HHcy in healthy and hypertensive subjects remain under-researched. METHODS A large population-based study was conducted in 60 communities from Shenzhen, China. Responses to standardized questions on lifestyle factors and blood samples were collected from all participants after a 12-h overnight fast. Multiple linear and multivariate logistic regressions were used to explore risk factors for HHcy. Results were then compared to those from a systematic review of English-language articles listed in Pubmed, EBSCOhost, Web of Science, Embase and Cochrane libraries that investigated HHcy risk factors in healthy and hypertensive subjects. RESULTS A total of 1586 healthy (Male/Female = 642/944) and 5935 hypertensive subjects (Male/Female = 2928/3007) participated in our population-based study. In logistic regression analyses, age, BMI and creatinine (Cr) were risk factors, while being female, fruit intake and physical activity were protective factors for HHcy in healthy subjects. In hypertensive subjects, seven [age, smoking, salt intake, systolic blood pressure (SBP), uric acid, triglycerides (TG), and Cr] and four [female, fruit intake, total cholesterol (TC), and glucose] factors were associated with higher and lower HHcy respectively. The review of 71 studies revealed that potential risk factors for Hcy included nutritional, physiologic, lifestyle habits, ethnicity, genetics, interactions between gene-environment, gene-gene, gene-nutritional, environment-environment, nutritional-nutritional. CONCLUSION Our study indicates the potential importance of increasing folic acid and vitamin B supplementation, daily fruit and vegetable intake, regular exercise and refraining from tobacco smoking and alcohol consumption as preventive strategies for Hcy.
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Pastore A, Noce A, Di Giovamberardino G, De Stefano A, Callà C, Zenobi R, Dessì M, Di Daniele N. Homocysteine, cysteine, folate and vitamin B₁₂ status in type 2 diabetic patients with chronic kidney disease. J Nephrol 2014; 28:571-6. [PMID: 25095762 DOI: 10.1007/s40620-014-0126-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyperhomocysteinemia (hHcy) is a risk factor in the progression of chronic kidney disease (CKD). In type 2 diabetes (T2D), hHcy is strongly associated with increased risk of cardiovascular disease. Vitamin B12 and folic acid supplementation have been reported to lower homocysteine (tHcy) levels, but no data on plasma tHcy, cysteine (Cys), folate and vitamin B12 levels in T2D-CKD patients are reported. PROCEDURES tHcy and Cys levels were analyzed in 178 T2D-CKD patients by high performance liquid chromatography (HPLC) with fluorescence detection. In addition, we determined folate and vitamin B12 levels using a chemiluminescence method. RESULTS tHcy and Cys levels were increased in T2D patients, and this rise positively correlated with the CKD stage (P < 0.001). Folate levels were comparable to controls at various CKD stages, whereas vitamin B12 levels were lower, except at stage IV. We did not find any correlation between B-vitamins and levels of tHcy and Cys, regardless of the CKD stage. CONCLUSIONS This is the first study reporting tHcy, Cys and B-vitamins status in T2D-CKD patients. Although limited to our cohort of 178 patients, our findings could be helpful in clarifying the conflicting literature regarding B-vitamins supplementation. Further studies are necessary before any Hcy-lowering therapy can be safely established in T2D-CKD subjects.
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Affiliation(s)
- Anna Pastore
- Metabolomic and Proteomic Unit, Children's Hospital "Bambino Gesù", IRCCS, P.zza S. Onofrio, 4, 00165, Rome, Italy.
| | - Annalisa Noce
- Department of Internal Medicine, Nephrology and Hypertension Unit, "Tor Vergata" University Hospital, Rome, Italy
| | - Gianna Di Giovamberardino
- Metabolomic and Proteomic Unit, Children's Hospital "Bambino Gesù", IRCCS, P.zza S. Onofrio, 4, 00165, Rome, Italy
| | | | - Cinzia Callà
- Department of Laboratory Medicine, "Policlinico Gemelli" University Hospital, Rome, Italy
| | - Rossella Zenobi
- Department of Laboratory Medicine, "Tor Vergata" University Hospital, Rome, Italy
| | - Mariarita Dessì
- Department of Laboratory Medicine, "Tor Vergata" University Hospital, Rome, Italy
| | - Nicola Di Daniele
- Department of Internal Medicine, Nephrology and Hypertension Unit, "Tor Vergata" University Hospital, Rome, Italy
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Rafeq Z, Roh JD, Guarino P, Kaufman J, Joseph J. Adverse myocardial effects of B-vitamin therapy in subjects with chronic kidney disease and hyperhomocysteinaemia. Nutr Metab Cardiovasc Dis 2013; 23:836-842. [PMID: 22902185 DOI: 10.1016/j.numecd.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/18/2012] [Accepted: 07/03/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Hyperhomocysteinaemia (HHCY), a common finding in patients with chronic kidney disease (CKD), has been shown to contribute to adverse cardiac remodelling and failure. We hypothesised that in human subjects with CKD, HHCY would be associated with myocardial dysfunction, and that homocysteine (HCY)-lowering therapy would improve myocardial remodelling and heart-failure (HF) outcomes. METHODS AND RESULTS Post hoc analysis of the Homocysteinemia in Kidney and End Stage Renal Disease (HOST) trial (n=2056) was performed to determine if HCY-lowering therapy with high dose B vitamins affects HF outcomes in patients with CKD. In addition, effects on myocardial remodelling were assessed in a subgroup of 220 trial subjects who had transthoracic echocardiograms done before study randomisation and during the course of the study as part of their routine clinical care. HF outcomes were not significantly affected by treatment compared to the placebo. HCY levels were inversely correlated with diastolic function (R=-0.21; p=0.038). Vitamin therapy resulted in a significant increase in left atrial size (+0.15±0.8 cm vs. -0.13±0.07 cm; p=0.0095). No other echocardiographic parameters were significantly associated with baseline HCY levels or changes with vitamin therapy. CONCLUSION HHCY is associated with diastolic dysfunction in patients with CKD. However, B-vitamin therapy did not improve HF outcomes despite lowering of plasma HCY levels, and was associated with an increase in left atrial size, which is a surrogate for worsening left ventricular diastolic dysfunction. These findings suggest that high-dose B vitamin therapy may be harmful in patients with CKD.
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Affiliation(s)
- Z Rafeq
- Veteran Affairs Boston Healthcare System, Department of Medicine, Boston, MA, USA
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Jardine MJ, Kang A, Zoungas S, Navaneethan SD, Ninomiya T, Nigwekar SU, Gallagher MP, Cass A, Strippoli G, Perkovic V. The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis. BMJ 2012; 344:e3533. [PMID: 22695899 PMCID: PMC3374481 DOI: 10.1136/bmj.e3533] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review the effect of folic acid based homocysteine lowering on cardiovascular outcomes in people with kidney disease. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, the Cochrane Library, and ClinicalTrials.gov to June 2011. STUDY SELECTION Randomised trials in people with non-dialysis dependent chronic kidney disease or end stage kidney disease or with a functioning kidney transplant reporting at least 100 patient years of follow-up and assessing the effect of folic acid based homocysteine lowering therapy. No language restrictions were applied. DATA EXTRACTION Two reviewers independently extracted data on study setting, design, and outcomes using a standardised form. The primary endpoint was cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality, or as defined by study author). Secondary endpoints included the individual composite components, all cause mortality, access thrombosis, requirement for renal replacement therapy, and reported adverse events, including haematological and neurological events. The effect of folic acid based homocysteine lowering on outcomes was assessed with meta-analysis using random effects models. RESULTS 11 trials were identified that reported on 4389 people with chronic kidney disease, 2452 with end stage kidney disease, and 4110 with functioning kidney transplants (10,951 participants in total). Folic acid based homocysteine therapy did not prevent cardiovascular events (relative risk 0.97, 95% confidence interval 0.92 to 1.03, P = 0.326) or any of the secondary outcomes. There was no evidence of heterogeneity in subgroup analyses, including those of kidney disease category, background fortification, rates of pre-existing disease, or baseline homocysteine level. The definitions of chronic kidney disease varied widely between the studies. Non-cardiovascular events could not be analysed as few studies reported these outcomes. CONCLUSIONS Folic acid based homocysteine lowering does not reduce cardiovascular events in people with kidney disease. Folic acid based regimens should not be used for the prevention of cardiovascular events in people with kidney disease.
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Affiliation(s)
- Meg J Jardine
- George Institute for Global Health, PO Box M201, Camperdown, NSW 2050, Australia.
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Shiao CC, Wu VC, Li WY, Lin YF, Hu FC, Young GH, Kuo CC, Kao TW, Huang DM, Chen YM, Tsai PR, Lin SL, Chou NK, Lin TH, Yeh YC, Wang CH, Chou A, Ko WJ, Wu KD. Late initiation of renal replacement therapy is associated with worse outcomes in acute kidney injury after major abdominal surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R171. [PMID: 19878554 PMCID: PMC2784403 DOI: 10.1186/cc8147] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 09/28/2009] [Accepted: 10/30/2009] [Indexed: 12/18/2022]
Abstract
Introduction Abdominal surgery is probably associated with more likelihood to cause acute kidney injury (AKI). The aim of this study was to evaluate whether early or late start of renal replacement therapy (RRT) defined by simplified RIFLE (sRIFLE) classification in AKI patients after major abdominal surgery will affect outcome. Methods A multicenter prospective observational study based on the NSARF (National Taiwan University Surgical ICU Associated Renal Failure) Study Group database. 98 patients (41 female, mean age 66.4 ± 13.9 years) who underwent acute RRT according to local indications for post-major abdominal surgery AKI between 1 January, 2002 and 31 December, 2005 were enrolled The demographic data, comorbid diseases, types of surgery and RRT, as well as the indications for RRT were documented. The patients were divided into early dialysis (sRIFLE-0 or Risk) and late dialysis (LD, sRIFLE -Injury or Failure) groups. Then we measured and recorded patients' outcome including in-hospital mortality and RRT wean-off until 30 June, 2006. Results The in-hospital mortality was compared as endpoint. Fifty-seven patients (58.2%) died during hospitalization. LD (hazard ratio (HR) 1.846; P = 0.027), old age (HR 2.090; P = 0.010), cardiac failure (HR 4.620; P < 0.001), pre-RRT SOFA score (HR 1.152; P < 0.001) were independent indicators for in-hospital mortality. Conclusions The findings of this study support earlier initiation of acute RRT, and also underscore the importance of predicting prognoses of major abdominal surgical patients with AKI by using RIFLE classification.
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Affiliation(s)
- Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital, 160 Chong-Cheng South Road, Lotung 265, I-Lan, Taiwan.
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Fibrates may Cause an Abnormal Urinary Betaine Loss Which is Associated with Elevations in Plasma Homocysteine. Cardiovasc Drugs Ther 2009; 23:395-401. [DOI: 10.1007/s10557-009-6188-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Li MD, Cheng TL, Tseng WL. Nonionic surfactant-capped gold nanoparticles for selective enrichment of aminothiols prior to CE with UV absorption detection. Electrophoresis 2009; 30:388-95. [DOI: 10.1002/elps.200800364] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Selective enrichment of aminothiols using polysorbate 20-capped gold nanoparticles followed by capillary electrophoresis with laser-induced fluorescence. J Chromatogr A 2008; 1216:288-93. [PMID: 19058808 DOI: 10.1016/j.chroma.2008.11.044] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/09/2008] [Accepted: 11/17/2008] [Indexed: 11/21/2022]
Abstract
In this article, we report a simple method for selective enrichment of aminothiols using Tween 20-capped gold nanoparticles (AuNPs) prior to capillary electrophoresis coupled with laser-induced fluorescence (CE-LIF). Compared to citrate-capped AuNPs, Tween 20-capped AuNPs exhibit the ability to disperse in a highly saline solution and selectively extract aminothiols through the formation of Au-S bonds. After extraction and centrifugation, 1mM thioglycollic acid (TGA) was utilized to remove aminothiols that attached to the NP surfaces. After a solution of 8.0 mL aminothiols were extracted using 2x AuNPs (200 microL), the extracted aminothiols derivatized with o-phthalaldehyde at pH 12.0 were detected by CE-LIF. As a result, the limits of detection at a signal-to-noise ratio of 3 for homocysteine (HCys), glutathione (GSH), and gamma-glutamycysteine (Glu-cys) are 4013.2, 79.8, and 382.8 pM, respectively. The use of this probe provided approximately 11-, 282-, and 21-fold sensitivity improvements for HCys, GSH, and Glu-cys, respectively. A practical analysis of HCys, GSH, and Glu-cys in human urine sample has been accomplished by this present method.
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Wu VC, Ko WJ, Chang HW, Chen YW, Lin YF, Shiao CC, Chen YM, Chen YS, Tsai PR, Hu FC, Wang JY, Lin YH, Wu KD. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med 2007; 34:101-8. [PMID: 17701162 DOI: 10.1007/s00134-007-0813-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 07/12/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for redialysis in postoperative patients with acute renal failure (ARF) who had previously been weaned from acute dialysis. Although recovery of renal function is anticipated in patients with ARF, no data have been reported on successful weaning from acute dialysis. DESIGN AND SETTING Retrospective observational case-control study in a 64-bed surgical ICU. PATIENTS AND METHODS Success in discontinuing dialysis was defined as cessation from dialysis for at least 30 days. A total of 304 postoperative patients who underwent acute renal replacement therapy in a surgical ICU between July 2002 and April 2005 were included. SOFA score biochemical data and renal function parameters were assessed on the day after the last session of renal replacement therapy, designated as day 0 (D0). RESULTS We could wean 94 patients (30.9%) from acute dialysis for more than 5 days, and 64 of these (21.1%) were successfully weaned for at least 30days. The independent predictors for resuming dialysis within 30 days were: (a) longer duration of dialysis (OR 1.06), (b) higher SOFA score on D0 (OR 1.44), (c) oliguria (urine output <100cc/8h; OR 4.17) on D1, and (d) age over 65 years (OR 6.35). The area under the ROC curve was 0.880. Two-way analysis of variance with repeated measurements over time showed a larger decline in SOFA score and an increase in urine output in patients with successful cessation of dialysis. Kaplan-Meier analysis showed a significant difference in early resumption of dialysis between patients with or without oliguria at D0. CONCLUSIONS More than two-thirds of patients weaned from postoperative acute dialysis for more than 5 days were free of dialysis for at least 30 days. Less urine output, longer duration of dialysis, age over 65 years, and higher disease severity score are predictive of a patient's redialysis after initial weaning from acute dialysis.
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Affiliation(s)
- Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
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