Journal
CLINICAL CHEMISTRY AND LABORATORY MEDICINE
Volume 39, Issue 8, Pages 681-690Publisher
WALTER DE GRUYTER & CO
DOI: 10.1515/CCLM.2001.112
Keywords
methionine; renal failure; homocystinuria; atherosclerosis; hyperhomocysteinemia; vascular disease
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Increased concentrations of homocysteine probably contribute to the high cardiovascular morbidity and mortality in hemodialysed end-stage renal disease (ESRD) patients and are determined by a variety of factors such as age, residual renal function, and vitamin status. Fasting plasma concentrations of total homocysteine, methionine, cysteine, and cystathionine were determined by gas chromatography-mass spectrometry (GC-MS) in 131 ESRD patients receiving daily oral folate (160-320 mug) and vitamin B-6 (10-20 mg) supplements. Concentrations of homocysteine determined by GC-MS were compared with those measured by high-performance liquid chromatography (HPLC) and an immunofluorescence method (IMx analyzer) using Passing-Bablok regression analysis. Mean plasma concentration of total homocysteine determined by GC-MS (28.7 +/-1.9 mu mol/l [mean +/- SD]) was significantly lower than that determined by HPLC (34.0 +/- 04.5 mu mol/l; p<0.001) or IMx (32.403.9 mu mol/l; p<0.001). A close correlation existed between GC-MS and HPLC (r=0.931; Y=1.203 x+0.279) and GC-MS and IMx (r=0.896; Y=1.105 x+0.766). Linear regression analysis showed positive correlations between plasma concentrations of homocysteine and cysteine (r=0.434; p<0.001) and homocysteine and cystathionine (r=0.187; p=0.032). Plasma concentrations of homocysteine correlated negatively with folate (r=-0.281; p=0.001) and vitamin B-12 (r=-0.229; p=0.009). GC-MS proved to be a sensitive and reliable method for the determination of total plasma homocysteine and related amino acids. Despite vitamin supplementation, ESRD patients requiring chronic maintenance hemodialysis, have high plasma concentrations of homocyst(e)ine which seems to be metabolized mainly within the transsulfuration pathway, while remethylation to methionine seems to be disturbed.
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