ESPN 51th Annual Meeting

ESPN 2018


 
Hyperhomocysteinemia in Children with Chronic Renal Failure and Renal Transplant Recipients
ELIF COMAK 1 MUSTAFA KOYUN 1 HALIDE AKBAS 2 SEMA AKMAN 1

1- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF PEDIATRICS, DIVISION OF PEDIATRIC NEPHROLOGY, ANTALYA, TURKEY
2- AKDENIZ UNIVERSITY, MEDICAL FACULTY, DEPARTMENT OF BIOCHEMISTRY, ANTALYA, TURKEY
 
Introduction:

Hyperhomocysteinemia frequently occurs in patients with chronic kidney disease (CKD) because of impaired renal metabolism and reduced renal excretion. Hyperhomocysteinemia is regarded as an independent predictor of cardiovascular morbidity and mortality in end-stage renal disease. Folic acid, the synthetic form of vitamin B9, is critical in the conversion of homocysteine to methionine. The aim of this study was to compare plasma homocysteine levels between pediatric renal transplant recipients and children with CKD.

Material and methods:

The children with renal transplantation and CKD (stages1-4) were enrolled in this study. Demographic data, anthropometric measures (weight, height), serum folic acid, vitamin B12, homocysteine, hemoglobin, MCV, iron transferrin saturation, ferritin, serum creatinine and albumin levels were evaluated. A serum homocysteine level higher than 15 µmol/L was defined as hyperhomocysteinemia.

Results:

A total of 176 children, median age 13.7 years (2.5-18 years), 70 CKD and 106 renal transplant recipients, were included in the study. The frequency of hyperhomocysteinemia was higher in children with CKD than renal transplant recipients (29.8% vs 10.8%, p=0.002). Also, plasma homocysteine levels in renal transplant recipients was significantly lower than children with CKD (10.13±5.85 umol/L vs 13.07±7.82 umol/L, p=0.01) Serum folic acid, vitamin B12, hemoglobin, MCV, ferritin, eGFR were similar between children with CKD and renal transplantion (all p>0.05). However, serum albumin level was higher in renal transplant recipients (p=0.000). In both groups, homocysteine level was significantly correlated with MCV (r=.22, P=.003), folic acid (r=-.34, P=.000), vitamin B12, (r=-.25, P=.001) and eGFR (r=-.34, P=.003). Plasma homocysteine and folic acid correlation was more prominent in CKD group (r=-.44, P=.000).

Conclusions:

Hyperhomocysteinemia is highly prevalent in children with CKD compared to pediatric renal transplant recipients. More attention should be given to diagnosis and treatment of hyperhomocysteinemia and folic acid and vitamin B12 deficiency to improve patient outcome in children with CKD.