Taes Youri E C, Delanghe Joris R, De Bacquer Dirk, Langlois Michel, Stevens Lut, Geerolf Inge, Lameire Norbert H, De Vriese An S
Laboratory Clinical Chemistry, University Hospital Ghent, Belgium.
Kidney Int. 2004 Dec;66(6):2422-8. doi: 10.1111/j.1523-1755.2004.66019.x.
Hyperhomocysteinemia is present in the majority of chronic hemodialysis patients. Treatment with folic acid, vitamin B12, and vitamin B6 cannot fully normalize plasma homocysteine concentrations (tHcy). Previously we have demonstrated the tHcy-lowering effect of creatine supplementation in an animal model of uremia (Kidney Int 64:1331-1337, 2003). The present study investigates the effects of creatine supplementation on tHcy in a vitamin-repleted chronic hemodialysis population.
Forty-five hemodialysis patients receiving folic acid and vitamin B6 and B12 were included. Patients were treated with creatine (2 g/day) or placebo during 2 treatment periods of 4 weeks, separated by a washout of 4 weeks. Plasma tHcy, creatine, Kt/V(urea), folic acid, vitamin B12, and routine biochemistry were determined, as well as the prognostic inflammatory and nutritional index.
All patients had elevated tHcy concentrations (21.2 +/- 5.6 micromol/L). Creatine treatment resulted in increased plasma and red blood cell creatine levels, documenting uptake of creatine. Creatine did not affect tHcy concentrations. There was no relationship between plasma creatine concentrations and tHcy concentrations. No changes in body weight, routine biochemistry, nutritional status, folic acid, or vitamin B12 were observed during the study.
Creatine supplementation at a rate of 2 g/day does not further decrease tHcy concentrations in chronic dialysis patients already treated with high dose folic acid, vitamin B6, and B12 supplementation.
大多数慢性血液透析患者存在高同型半胱氨酸血症。使用叶酸、维生素B12和维生素B6治疗不能使血浆同型半胱氨酸浓度（总同型半胱氨酸，tHcy）完全恢复正常。此前我们已在尿毒症动物模型中证明补充肌酸具有降低tHcy的作用（《肾脏病国际》64:1331 - 1337，2003年）。本研究调查了在补充维生素的慢性血液透析人群中补充肌酸对tHcy的影响。
纳入45例接受叶酸、维生素B6和B12治疗的血液透析患者。患者在两个为期4周的治疗期内分别接受肌酸（2克/天）或安慰剂治疗，中间间隔4周的洗脱期。测定血浆tHcy、肌酸、Kt/V（尿素）、叶酸、维生素B12和常规生化指标，以及预后炎症和营养指标。
所有患者的tHcy浓度均升高（21.2±5.6微摩尔/升）。肌酸治疗导致血浆和红细胞肌酸水平升高，证明肌酸被摄取。肌酸不影响tHcy浓度。血浆肌酸浓度与tHcy浓度之间无相关性。研究期间未观察到体重、常规生化指标、营养状况、叶酸或维生素B12的变化。
对于已接受高剂量叶酸、维生素B6和B12补充治疗的慢性透析患者，每天补充2克肌酸并不能进一步降低tHcy浓度。
