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Serum Cystatin C as a Determinant of Fasting Total Homocysteine Levels in Renal Transplant Recipients with a Normal Serum Creatinine

ANDREW G. BOSTOM^*,, REGINALD Y. GOHH, LINDA BAUSSERMAN^§, DAVID HAKAS, PAUL F. JACQUES, JACOB SELHUB, LANCE DWORKIN and IRWIN H. ROSENBERG

^* Division of General Internal Medicine, Memorial Hospital of Rhode Island, Providence, Rhode Island.
Tufts Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, Massachusetts.
Division of Renal Diseases, Rhode Island Hospital, Providence, Rhode Island.
^§ Lipid Research Laboratory, The Miriam Hospital, Providence, Rhode Island.

Correspondence to Dr. Andrew G. Bostom, Division of General Internal Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860. Phone: 401-729-2859; Fax: 401-729-2950; E-mail: abostom{at}loa.com

Abstract

Abstract. Serum creatinine, a surrogate for both renal function and homocysteine generation, is an important determinant of fasting plasma total homocysteine levels in stable renal transplant recipients. In this study, it is hypothesized that among stable renal transplant recipients with normal creatinine levels (i.e., 1.5 mg/dl), serum cystatin C, a more sensitive indicator of GFR, would better predict fasting total homocysteine levels compared with serum creatinine. Fasting plasma total homocysteine, folate, vitamin B₁₂, and pyridoxal 5'-phosphate levels, along with serum cystatin C, creatinine, and albumin levels, were determined in 28 consecutive renal transplant recipients (mean age 47 ± 14 yr; 60.7% men) with stable allograft function, whose serum creatinine was 1.5 mg/dl. General linear modeling with analysis of covariance revealed that serum cystatin C was independently predictive (partial R = 0.494; P = 0.023) of fasting total homocysteine levels after adjustment for age, gender, vitamin status, albumin, and creatinine levels. In contrast, creatinine levels were not predictive of fasting total homocysteine levels in this model (P = 0.110) or an identical model that excluded cystatin C (P = 0.131). Serum cystatin C levels may reflect subtle decreases in renal function that independently predict fasting total homocysteine levels among stable renal transplant recipients with a normal serum creatinine.

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