Publication: Resistencia de la hiperhomocisteinemia del paciente renal al tratamiento con dosis suprafisiológicas de ácido fólico parenteral
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Identifiers
Date
2008
Authors
Palomares Bayo, M
Oliveras López, M J
Osuna Ortega, A
Asensio Peinado, C
Quesada Granados, J J
López García de la Serrana, H
López Martínez, M C
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
Grupo Aula Médica, S.L.
Abstract
Los pacientes en hemodiálisis presentan un aumento de homocisteína plasmática (Hcy), debido a la alteración en la metilación causada por la uremia y déficit de los cofactores necesarios (vitamina B, ácido fólico). Esto se correlaciona con un mayor desarrollo de la enfermedad vascular prematura. El tratamiento, no está consensuado, siendo escasa la respuesta a la administración oral de dosis convencionales de ácido fólico. En este trabajo valoramos la respuesta de la hiperhomocisteinemia de 73 pacientes en programa de hemodiálisis periódica tras la administración de 50 mg de ácido folínico parenteral durante 18 meses. La homocisteína plasmática de los pacientes en el momento de inicio del estudio presentaba unos valores medios de 22,67 (µmol/l). Durante el primer año de suplementación mantuvieron el valor medio de 20 µmol/l. A partir del primer año de tratamiento, y hasta finalizar los 18 meses de observación, los niveles medios de homocisteína fueron de 19,58 µmol/l. Aunque con el tiempo de tratamiento encontramos una clara tendencia al descenso de sus valores plasmáticos, no existieron diferencias estadísticamente significativas. Los valores de homocisteína no se normalizaron en ninguno de los pacientes tratados.
Hemodialysis patients present an increase in plasma homocysteine (Hcy) due to methylation impairment caused by uremia and the deficiency of the co-factors needed (vitamin B, folic acid). This correlates with a more common development of premature vascular disease. There is no consensus on the therapy, with a poor response to oral administration of conventional doses of folic acid. In this work, we assessed the response of hyperhomocysteinemia in 73 regular hemodialysis patients after the administration of 50 mg of parenteral folinic acid for 18 months. Plasma homocysteine of the patients at the time of the study beginning presented mean values of 22.67 (micromol/L). During the first year of supplementation the mean value was kept at 20 micromol/L. From the first year to the end of the 18-months observation period the mean homocysteine levels were 19.58 micromol/L. Although we found a clear trend towards a decrease in plasma homocysteine levels during the treatment period, there were no significant differences. Homocysteine levels did not come back to normal in none of the patients treated.
Hemodialysis patients present an increase in plasma homocysteine (Hcy) due to methylation impairment caused by uremia and the deficiency of the co-factors needed (vitamin B, folic acid). This correlates with a more common development of premature vascular disease. There is no consensus on the therapy, with a poor response to oral administration of conventional doses of folic acid. In this work, we assessed the response of hyperhomocysteinemia in 73 regular hemodialysis patients after the administration of 50 mg of parenteral folinic acid for 18 months. Plasma homocysteine of the patients at the time of the study beginning presented mean values of 22.67 (micromol/L). During the first year of supplementation the mean value was kept at 20 micromol/L. From the first year to the end of the 18-months observation period the mean homocysteine levels were 19.58 micromol/L. Although we found a clear trend towards a decrease in plasma homocysteine levels during the treatment period, there were no significant differences. Homocysteine levels did not come back to normal in none of the patients treated.
Description
MeSH Terms
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Diseases::Congenital, Hereditary, and Neonatal Diseases and Abnormalities::Genetic Diseases, Inborn::Metabolism, Inborn Errors::Amino Acid Metabolism, Inborn Errors::Hyperhomocysteinemia
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Pteridines::Pterins::Folic Acid::Tetrahydrofolates::Formyltetrahydrofolates::Leucovorin
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis
Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency
Medical Subject Headings::Phenomena and Processes::Physiological Phenomena::Pharmacological Phenomena::Drug Resistance
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Diseases::Congenital, Hereditary, and Neonatal Diseases and Abnormalities::Genetic Diseases, Inborn::Metabolism, Inborn Errors::Amino Acid Metabolism, Inborn Errors::Hyperhomocysteinemia
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Pteridines::Pterins::Folic Acid::Tetrahydrofolates::Formyltetrahydrofolates::Leucovorin
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis
Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency
Medical Subject Headings::Phenomena and Processes::Physiological Phenomena::Pharmacological Phenomena::Drug Resistance
DeCS Terms
CIE Terms
Keywords
Ácido fólico, Paciente renal, Hemodiálisis, Hiperhomocisteinemia, Renal patient, Folic acid, Hemodialysis, Hyperhomocysteinemia, Femenino, Humanos, Leucovorina, Diálisis renal, Resistencia a medicamentos, Femenino, Humanos, Masculino, Mediana edad, Insuficiencia renal
Citation
Bayo MP, López MJ, Ortega AO, Peinado CA, Granados JJ, de la Serrana HL, et al. Resistencia de la hiperhomocisteinemia del paciente renal al tratamiento con dosis suprafisiológicas de ácido fólico parenteral. Nutr Hosp. 2008 May-Jun;23(3):268-76