HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Davies, L. Articles by Fulcher, G. R. Search for Related Content PubMed PubMed Citation Articles by Davies, L. Articles by Fulcher, G. R. Social Bookmarking                What's this?

The Relationship Among Homocysteine, Creatinine Clearance, and Albuminuria in Patients With Type 2 Diabetes

¹ Department of Diabetes, Endocrinology, and Metabolism, Royal North Shore Hospital, St. Leonards, Australia

OBJECTIVE—Although it is accepted that elevated plasma homocysteine (tHcy) levels occur in end-stage renal disease and type 2 diabetes, the changes with milder renal dysfunction (e.g., microalbuminuria) are less clearly established. This study explores the relationship among tHcy, creatinine clearance (Ccr), and albumin excretion rate (AER) in a population with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 260 patients with type 2 diabetes were screened in our outpatient clinic during 10 months. Fasting blood samples were collected, and AER was calculated from an overnight timed urine sample. Ccr was calculated using the Cockroft-Gault formula.

RESULTS—A total of 198 subjects (76%) had normoalbuminuria (<20 µg/min), 50 subjects (19%) had microalbuminuria (20–200 µg/min), and 12 subjects (5%) had macroalbuminuria (200 µg/min). Those with microalbuminuria had higher levels of tHcy than those with normoalbuminuria (13.2 ± 7.8 vs. 11.3 ± 4.6 µmol/l, P < 0.05). Patients were then subdivided based on low Ccr (<80 ml · min^-1 · 1.73 m^-2) and normal Ccr (80 · min ^-1 · 1.73 m^-2). None of the patients with macroalbuminuria had normal Ccr. In those with normoalbuminuria, tHcy levels were higher than in those with low Ccr than in those with normal Ccr (12.0 ± 4.6 vs. 10.0 ± 4.4 µmol/l, P < 0.01). The same was found for those with microalbuminuria (low Ccr versus normal Ccr: 14.6 ± 9.0 vs. 10.2 ± 2.8 µmol/l, P < 0.02). For normal Ccr, tHcy was similar irrespective of AER (normoalbuminuria versus microalbuminuria: 10.0 ± 4.4 vs. 10.2 ± 2.8 µmol/l, NS). For low Ccr, tHcy was higher in those with microalbuminuria versus normoalbuminuria (14.6 ± 9.0 vs. 12.0 ± 4.6 µmol/l, P = 0.01). Using multivariate regression, Ccr, but neither AER nor the presence of albuminuria, was an independent predictor of tHcy.

CONCLUSIONS—These data strongly suggest that in patients with type 2 diabetes, the relationship between plasma tHcy and AER is largely due to associated changes in renal function, as defined by Ccr.

Abbreviations: AER, albumin excretion rate • Ccr, creatinine clearance • Scr, serum creatinine • tHcy, homocysteine

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. P. Kovesdy, B. K. Trivedi, K. Kalantar-Zadeh, and J. E. Anderson Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1257 - 1262. [Abstract] [Full Text] [PDF]

				V. Menon, M. J. Sarnak, T. Greene, X. Wang, A. A. Pereira, G. J. Beck, J. W. Kusek, J. Selhub, A. J. Collins, A. S. Levey, et al. Relationship Between Homocysteine and Mortality in Chronic Kidney Disease Circulation, March 28, 2006; 113(12): 1572 - 1577. [Abstract] [Full Text] [PDF]

				E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol. Dial. Transplant., March 1, 2005; 20(3): 497 - 508. [Full Text] [PDF]

				Y. Aso, K.-i. Okumura, K. Takebayashi, S. Wakabayashi, and T. Inukai Relationships of Plasma Interleukin-18 Concentrations to Hyperhomocysteinemia and Carotid Intimal-Media Wall Thickness in Patients With Type 2 Diabetes Diabetes Care, September 1, 2003; 26(9): 2622 - 2627. [Abstract] [Full Text] [PDF]

				J.-M. Gonzalez-Clemente, R. Deulofeu, J. Mitjavila, G. Galdon, E. Ortega, A. Caixas, G. Gimenez-Perez, and D. Mauricio Plasma Homocysteine Is not Increased in Microalbuminuric Patients With Type 2 Diabetes Without Clinical Cardiovascular Disease Diabetes Care, March 1, 2002; 25(3): 632 - 633. [Full Text] [PDF]