Interventions for lowering plasma homocysteine levels in dialysis patients

Nigwekar, Sagar U.; Kang, Amy; Zoungas, Sophia; Cass, Alan; Gallagher, Martin; Kulshrestha, Satyarth; Navaneethan, Sankar D.; Perkovic, Vlado; Strippoli, Giovanni F.M.; Jardine, Meg

doi:10.1002/14651858.cd004683.pub4

Cited by 24 publications

(20 citation statements)

References 143 publications

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“…[ 40 , 41 ] In the present study, vitamin B significantly associates with low serum phosphorus, high serum phosphorus, high calcium–phosphorus product, and hyperkalemia, but vitamin B group does not show the association with other CVD risk factors, the result contributes to the evidence for clinical practice. [ 42 ] This suggests more attention on the specific subgroups or different level of CVD risk factors to have more precise decision on the vitamin B therapy. Especially in the situation of a high proportion of patients with insufficient dietary vitamin B intake in the current and the previous study.…”

Section: Discussionmentioning

confidence: 99%

Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients

Duong¹,

Wong

et al. 2018

Medicine

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The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients.A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-weekly hemodialysis treatment for at least 3 months, adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/d) from 7 hospital-based hemodialysis centers in Taiwan. The dietary intake was evaluated by the 3-day dietary record, and a 24-hour dietary recall. Biochemical parameters were archived from laboratory tests. The cardiovascular disease (CVD) risk factors were defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. The adequate dietary intake of macronutrients and micronutrients was recommended by the European Best Practice Guidelines, K/DOQI, and Institute of Medicine guidelines. Logistic regression analysis was used.All hemodialysis patients had CVD risks, the lowest proportion of patients with adequate intake of macronutrients and micronutrients were 8.7% and 1.8%, respectively. The adequate dietary intake associated with lower likelihood of having CVD risks in hemodialysis patient by 47% to 84%, including 39% to 58% lower hypertension, 37% to 50% lower dyslipidemia, 42% to 63% diabetes mellitus, 44% to 84% lower obesity, 58% lower low calcium, 38% lower hyperparathyroidism, 47% to 64% lower hyperhomocysteinemia, and 41% to 67% lower inflammation, 63% to 74% lower hypoalbumin, 73% lower inadequate normalized protein nitrogen appearance.Adequate dietary nutrients intake may reduce the cardiovascular risks factors, in turn, to prevent the cardiovascular morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients

Duong¹,

Wong

et al. 2018

Medicine

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“…Several studies of homocysteine-lowering treatments have shown a favorable effect on vascular pathologies associated with hyperhomocysteinemia [ 257 , 263 , 264 ]. However, other studies and meta-analyses have demonstrated that lowering homocysteine using B vitamins had no significant effect on stroke prevention [ 260 , 261 , 265 , 266 ], prevention of myocardial infarction [ 260 , 261 , 266 , 267 , 268 , 269 , 270 ], individual or global cognitive function [ 271 , 272 , 273 ], or other pathological conditions [ 274 , 275 , 276 ].…”

Section: Nutrients and Their Metabolites And Enzymes Related To Dnmentioning

confidence: 99%

Polyamine Metabolism and Gene Methylation in Conjunction with One-Carbon Metabolism

Soda

2018

IJMS

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Recent investigations have revealed that changes in DNA methylation status play an important role in aging-associated pathologies and lifespan. The methylation of DNA is regulated by DNA methyltransferases (DNMT1, DNMT3a, and DNMT3b) in the presence of S-adenosylmethionine (SAM), which serves as a methyl group donor. Increased availability of SAM enhances DNMT activity, while its metabolites, S-adenosyl-l-homocysteine (SAH) and decarboxylated S-adenosylmethionine (dcSAM), act to inhibit DNMT activity. SAH, which is converted from SAM by adding a methyl group to cytosine residues in DNA, is an intermediate precursor of homocysteine. dcSAM, converted from SAM by the enzymatic activity of adenosylmethionine decarboxylase, provides an aminopropyl group to synthesize the polyamines spermine and spermidine. Increased homocysteine levels are a significant risk factor for the development of a wide range of conditions, including cardiovascular diseases. However, successful homocysteine-lowering treatment by vitamins (B6, B12, and folate) failed to improve these conditions. Long-term increased polyamine intake elevated blood spermine levels and inhibited aging-associated pathologies in mice and humans. Spermine reversed changes (increased dcSAM, decreased DNMT activity, aberrant DNA methylation, and proinflammatory status) induced by the inhibition of ornithine decarboxylase. The relation between polyamine metabolism, one-carbon metabolism, DNA methylation, and the biological mechanism of spermine-induced lifespan extension is discussed.

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“…Folic acid therapy significantly reduced the risk of CVEs (RR 0.85, 0.76-0.96, p = 0.009), with the greatest benefit seen in patients that had a longer duration of therapy, no or partial folic acid fortification and a > 20% decrease in homocysteine levels. However, a subsequent meta-analysis of 6 RCTs involving 2452 ESKD patients only found that homocysteinelowering therapy had little or no effect on all-cause or cardiovascular mortality [143].…”

Section: Qin Et Al Performed a Meta-analysis Of 7 Randomised Trials mentioning

confidence: 99%

Cardiovascular Disease in Dialysis Patients

Jegatheesan¹,

Yang²,

Krishnasamy³

et al. 2018

Aspects in Dialysis

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Cardiovascular disease (CVD) is highly prevalent in the dialysis population, affecting up to 60% of cohorts. Cardiovascular mortality rates are reported to be ~14 per 100 patient-years, which are 10-to 20-fold greater than those of age-and gender-matched controls. CVD is the primary cause of death in up to 40% of dialysis patients in Australia, New Zealand and the United States. Dialysis patients endure a greater burden of both traditional risk factors for CVD and risk factors related to loss of kidney function that may account for the higher CVD morbidity and mortality. Many cardiology guidelines include chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as coronary heart disease (CHD) risk equivalents. It is therefore important for clinicians to both recognise and optimise the cardiovascular health of patients receiving maintenance dialysis. This chapter will focus on risk factor modification, screening and prevention of CVD in dialysis patients.

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Interventions for lowering plasma homocysteine levels in dialysis patients

Cited by 24 publications

References 143 publications

Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients

Associations of dietary macronutrients and micronutrients with the traditional and nontraditional risk factors for cardiovascular disease among hemodialysis patients

Polyamine Metabolism and Gene Methylation in Conjunction with One-Carbon Metabolism

Cardiovascular Disease in Dialysis Patients

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