Hamatani Ryoko, Otsu Miki, Chikamoto Hiroko, Akioka Yuko, Hattori Motoshi
Department of Pediatric Nephrology, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Clin Exp Nephrol. 2014 Feb;18(1):151-6. doi: 10.1007/s10157-013-0819-3. Epub 2013 Jun 4.
Hyperhomocysteinemia (hyper-Hcy) is an important and reversible cardiovascular disease risk factor. We examined the prevalence of hyper-Hcy, plasma folate levels, and dietary folate intake in adolescents and young adults who had undergone kidney transplantation during childhood to assess the necessity for managing dietary folate.
This cross-sectional study was performed in 89 kidney transplant recipients (age at kidney transplantation: 12.6 ± 4.1 years; age during study: 21.2 ± 5.5 years). Hyper-Hcy and plasma folate deficiency were defined as plasma homocysteine (Hcy) >15 nmol/ml and plasma folate <3.0 ng/ml, respectively.
Of the patients, 60 (67.4 %) had hyper-Hcy and 14 (15.7 %) had plasma folate deficiency. Plasma homocysteine levels correlated negatively with estimated glomerular filtration rate (eGFR; r = -0.565, p < 0.01) and plasma folate levels (r = -0.434, p < 0.01). For determinants of plasma homocysteine levels, a priori selected variables included kind of calcineurin inhibitor, age at kidney transplantation, pretransplant duration of dialysis, time since transplantation, age at examination, eGFR, and plasma folate. Stepwise multiple linear regression analysis revealed eGFR and plasma folate levels as significant independent variables influencing plasma homocysteine levels. Dietary folate intake in 11 of 16 patients (66.8 %) with eGFR ≥ 60 ml/min/1.73 m(2) was below the recommended dietary allowance for Japanese.
The prevalence of hyper-Hcy and plasma folate deficiency, as well as the low dietary folate intake, suggest that dietary management of folate is necessary for adolescents and young adults who have undergone kidney transplantation during childhood.
高同型半胱氨酸血症（高Hcy）是一种重要且可逆的心血管疾病危险因素。我们调查了儿童期接受肾移植的青少年和青年成人中高Hcy的患病率、血浆叶酸水平和膳食叶酸摄入量，以评估管理膳食叶酸的必要性。
这项横断面研究纳入了89例肾移植受者（肾移植时年龄：12.6±4.1岁；研究期间年龄：21.2±5.5岁）。高Hcy和血浆叶酸缺乏分别定义为血浆同型半胱氨酸（Hcy）>15 nmol/ml和血浆叶酸<3.0 ng/ml。
患者中，60例（67.4%）有高Hcy，14例（15.7%）有血浆叶酸缺乏。血浆同型半胱氨酸水平与估计肾小球滤过率（eGFR；r = -0.565，p < 0.01）和血浆叶酸水平（r = -0.434，p < 0.01）呈负相关。对于血浆同型半胱氨酸水平的决定因素，预先选择的变量包括钙调神经磷酸酶抑制剂的种类、肾移植时的年龄、移植前透析持续时间、移植后的时间、检查时的年龄、eGFR和血浆叶酸。逐步多元线性回归分析显示，eGFR和血浆叶酸水平是影响血浆同型半胱氨酸水平的重要独立变量。16例eGFR≥60 ml/min/1.73 m²的患者中，11例（66.8%）的膳食叶酸摄入量低于日本的推荐膳食摄入量。
高Hcy和血浆叶酸缺乏的患病率以及低膳食叶酸摄入量表明，对于儿童期接受肾移植的青少年和青年成人，膳食叶酸管理是必要的。
