Interventions for lowering plasma homocysteine levels in kidney transplant recipients

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

doi:10.1002/14651858.cd007910.pub2

Cited by 5 publications

(4 citation statements)

References 57 publications

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“…It is also important to stress that there is some degree of controversy regarding the benefit of hyperhomocysteinemia control in CKD patients. Some studies have observed that lowering homocysteine did not necessarily reduce CVD risk in this group of patients [50,52]. Similarly, in our patient cohort, we can propose a comparable argument-that cfDNA levels in certain patients are not significantly influenced by homocysteine levels.…”

Section: Discussionsupporting

confidence: 77%

Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation

Leotta,

Hernandez,

Tothova

et al. 2023

Cells

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Circulating cell-free DNA (cfDNA) has diverse applications in oncological, prenatal, toxicological, cardiovascular, and autoimmune diseases, diagnostics, and organ transplantation. In particular, mitochondrial cfDNA (mt-cfDNA) is associated with inflammation and linked to early vascular ageing (EVA) in end-stage kidney failure (ESKF), which could be a noninvasive marker for graft rejection and organ damage. Plasma samples from 44 ESKF patients, of whom half (n = 22) underwent either conservative therapy (non-HD) or hemodialysis (HD) before kidney transplantation (KT). These samples were analyzed at baseline and two years after KT. cfDNA was extracted from plasma and quantified using the fluorometric method. qPCR was used to quantify and differentiate the fractions of mt-cfDNA and nuclear cfDNA (nc-cfDNA). mt-cfDNA levels in KT patients decreased significantly from baseline to two years post-KT (p < 0.0268), while levels of total cfDNA and nc-cfDNA did not differ. Depending on therapy modality (HD vs. non-HD) before KT, total cfDNA levels were higher in HD patients at both baseline (p = 0.0133) and two years post-KT (p = 0.0421), while nc-cfDNA levels were higher in HD only at baseline (p = 0.0079). Males showed a nonsignificant trend of higher cfDNA levels. Patients with assessed vascular fibrosis (p = 0.0068), either alone or in combination with calcification plus fibrosis, showed reduced mt-cfDNA post-KT (p = 0.0195). Changes in mt-cfDNA levels suggests the impact of KT on the inflammatory state of ESKF, as evidenced via its correlation with high sensitivity C-reactive protein after KT. Further studies are warranted to assess if cfDNA could serve as a noninvasive method for monitoring the response to organ transplantation and even for amelioration of EVA status per se.

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Section: Discussionsupporting

confidence: 77%

Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation

Leotta,

Hernandez,

Tothova

et al. 2023

Cells

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“…In the early stages of CKD, the use of -blockers, renin-angiotensin blockers, diuretics, statins, and aspirin is beneficial [ 58 ]. These days, several bacteria, including Propionibacterium freudenreichii , P. shermanii , and Pseudomonas dentrificans , are employed to produce synthetic cobalamin artificially [ 56 ]. In some countries, food products like cereals are fortified with Cbl, respectively, for better nutrition profiles among the population.…”

Section: Methodsmentioning

confidence: 99%

Homocysteine, Vitamin B12 and Folate Level: Possible Risk Factors in the Progression of Chronic Heart and Kidney Disorders

Mohan

Kumar

et al. 2023

CCR

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Cobalamin is an essential molecule for humans; it is exceptionally important for various body functions, including deoxyribonucleic acid synthesis and cellular energy production. Vegans are more vulnerable to vitamin B12 deficiency than natives with moderate consumption of animal dietary supplements or people with inadequate nutritional patterns. However, the long-term effects of sub-medical deficiency have not been thoroughly studied, but they may have a negative impact on the cardiovascular system, pregnancy outcomes, and vascular, renal, cognitive, bone, and eye health. Alongside the statin remedy, that is a powerful approach for CVD prevention. Another approach is related to the B nutrition substitution remedy with folic acid, and vitamins B6 and B12 are extensively practised nowadays. There is a tremendous interest in plasma homocysteine (tHcy) as a cardiovascular hazard factor. However, current research in the field of its prevention is more inclined toward confirming the benefit of a tHcy-reducing remedy with nutrition B12. Thus, while folic acid fortification is primarily aimed at reducing neural-tube defects, it may also play a significant role in the primary prevention of CVD by lowering tHcy. Folate and B-vitamins play important roles in CVD prevention and nutrition policy implementation. Patients affected by Chronic Kidney Disease (CKD) or end-stage Stage Renal Disease (ESRD) experience a tremendous cardiovascular threat that may also further lead to death. As a result, routine monitoring of vitamin B12 levels is likely to be beneficial for the early detection and treatment of metabolic vitamin B12 deficiency, as well as the prevention of heart-related diseases.

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“…In a large randomized controlled trial, 4110 stable KT recipients were assigned to a high dose or low dose of multivitamin therapy, which included folic acid and vitamins B6 and B12. Treatment with a high-dose multivitamin preparation did not reduce a composite CVD outcome or all-cause mortality, despite significant reduction in homocysteine level [ 113 ]. A large review of the literature also concluded that there is no evidence to support the use of homocysteine-lowering therapy for cardiovascular disease prevention in KT recipients [ 114 ].…”

Section: Hyperhomocysteinemiamentioning

confidence: 99%

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

Reggiani

Moroni

Ponticelli³

2022

JPM

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Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.

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Interventions for lowering plasma homocysteine levels in kidney transplant recipients

Abstract: Interventions for lowering plasma homocysteine levels in kidney transplant recipients.

Cited by 5 publications

References 57 publications

Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation

Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation

Homocysteine, Vitamin B12 and Folate Level: Possible Risk Factors in the Progression of Chronic Heart and Kidney Disorders

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

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