| Theme |
Homocysteinemia in Association with Chronic Renal Failure |
| Title |
Hyperhomocysteinemia and unsaturated fatty acids in patients with dialysis |
| Author |
Satoru Hirose |
Fourth Department of Internal Medicine, Saitama Medical Center, Saitama Medical School |
| Author |
Tetsuya Mitarai |
Fourth Department of Internal Medicine, Saitama Medical Center, Saitama Medical School |
| [ Summary ] |
A great deal of attention has been focused on hyperhomocysteinemia as one of the risk factors for atherosclerosis. Hyperhomocysteinemia is detected in the patients with end-stage renal disease. Lipid metabolism disorders, a prominent risk factor for atherosclerosis, are also observed in patients with end-stage renal disease. There are however no studies of the relationship between hyperhomocysteinemia and lipid metabolism disorders in these patients. Hyperhomocysteinemia may induce atherosclerosis by direct injury of the vascular endothelial cells and by production of oxidated low-density lipoproteins, proceeding from the generation of active oxygen. We treated hyperhomocysteinemia in CAPD patients by using folic acid supplementation and evaluated the effects of hyperhomocysteinemia on lipid peroxydation by observing changes in serum concentrations of unsaturated fatty acids. Liner regression analysis revealed a significant negative correlation between plasma concentrations of total homocysteine and serum concentrations of vitamin E. Therefore this indicates that peroxydation of low-density lipoprotein, induced by homocysteine, may precede depletion of vitamin E contained in low density lipoprotein in patients with dialysis and with hyperhomocysteinemia. Moreover, serum concentrations of both dihomo-gamma-linolenic acid and arachidonic acid in CAPD patients with hyperhomocysteinemia were significantly lower than those of CAPD patients with normohomocysteinemia. Serum concentrations of these unsaturated fatty acids in CAPD patients, with hyperhomocysteinemia, increased significantly after correction of hyperhomocysteinemia by administering folic acid supplementation. The increase of serum concentrations of unsaturated fatty acids may be aresult of the increase of the seconcentrations in low-density lipoprotein. These findings suggest that the correction of hyperhomocysteinemia in patients with dialysis ease inhibits peroxydation of low-density lipoprotein and produces beneficial effects concerning the prevention of atherosclerosis. |