Homocysteine in Children with End Stage Renal Disease

Kang, Hee Gryung; Lee, Joo Hoon; Hahn, Hye Woon; Park, Kyung Mee; Ha, Il Soo; Cheong, Hae Il; Choi, Yong

Abstract

Hyperhomocysteinemia is an independent risk factor for atherosclerotic complications in adult patients with chronic renal failure. Data on hyperhomocysteinemia in children with chronic renal failure are not sufficient. In the present study we investigated plasma homocysteine concentration status in children with chronic renal failure, factors correlating plasma homocysteine concentration, and the effect of folate dose increase. We measured fasting plasma homocysteine, folate, vitamin B12, creatinine concentration in 32 children on dialysis and 21 non-renal patients as controls. Then, 21 children of 32 on dialysis were prescribed 2.5mg folic acid daily, instead of 0.8mg daily. Mean fasting plasma homocysteine concentration was 13.8 micromol/L in end-stage renal disease patients and 7.5micromol/L in controls. Serum folate and vitamin B12 concentrations are higher in ESRD patients. Patients on peritoneal dialysis showed higher serum folate concentrations than patients on hemodialysis. Homocysteine levels were significantly correlated with age and creatinine, and negatively correlated with folate and vitamin B12 levels in patients. After 4 weeks of folic acid dose increase, homocysteine levels of patients on hemodialysis were decreased, which contrast with patients on peritoneal dialysis. Children with end-stage renal disease have elevated plasma homocysteine concentrations with 0.8mg folic acid daily, and folic acid dose increase to 2.5mg daily lowers homocysteine level in patients on hemodialysis. It is suggested that folic acid dose be increased for children on hemodialysis to decrease homocysteine level, although a beneficial effect has to be proven.