Sulfur-containing amino acids, C-reactive protein, Vitamin B12, folate and mortality in haemodialysis patients

Abstract

Cardiovascular disease (CVD) is common in haemodialysis (HD) patients with chronic renal insufficiency and is the leading cause of death. The accelerated state of atherosclerosis found in these patients is due to a combination of different mechanisms. Recent studies confirm that inflammation plays an important role in the development of atherosclerosis. Plasma SAA, CRP, B₁₂ and folate in three different groups of patients with chronic renal failure (CRF) (one group without dialysis under conservative treatment, one pre-haemodialysis and one post-haemodialysis) were investigated and compared to control group. Our study aimed to analyze, whether there is a relationship between the plasma concentration of SAA, CRP as a predictor of mortality in HD patients as well as systemic vitamin concentration, measured as levels of vitamin B₁₂ and folate. The present study shows that many abnormalities are observed in plasma SAA concentrations in all patient groups accompanied with increase level of CRP. The patients with uremia have evidence of slight deficiency in folate and vitamin B12 levels. Based on theoretical and practical background of other studies, supplementation with both folate and vitamin B₁₂ is recommended to normalize the detected abnormalities in SAA concentrations especially Hcys and hence has a beneficial effect on the cardiovascular risk in CRF and dialysis patients. These results suggest that SAA and inflammation are the main risk factor for mortality in haemodialysis patients. Further studies are required to demonstrate that this effect is associated with an improved in morbidity and mortality. As the study was carried out in a relatively limited number of patients, the results need to be confirmed in a larger patient population.

Keywords: SAA, CRP, vitamin B₁₂, Folate, mortality

Egyptian Journal of Biochemistry and Molecular Biology Vol. 24 (2) 2006: pp. 111-129