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Methylmalonic Acid in Dialysis Patients
Author(s) -
Svoboda L.,
Stráník L.,
Hyánek J.,
Pehal F.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01271.x
Subject(s) - methylmalonic acid , cobalamin , vitamin b12 , cyanocobalamin , medicine , hyperhomocysteinemia , methylcobalamin , homocysteine , gastroenterology , methylmalonic acidemia , folic acid , endocrinology
Propionyl‐CoA is a common product of metabolism of essential AA (Val, Thr, Leu, Ile), fatty acids and cholesterol and is further metabolised enzymatically to methyl‐malonyl CoA, which is further isomerised to succinyl CoA. Because of the common cofactor (cobalamin) methylmalonic acid (Mma) can serve as an early marker of functional cobalamin deficiency. Purpose of the study : To evaluate possible hidden cobalamin deficiency and the effect of treatment with iv. vit B12 on Mma and tot. homocystein (tHcy) levels in dialysis patients (pts). Methods : 48 HD treated pts, in routine medication folic acid 5 mg/d, pyridoxin 20 mg/d. Measurement of serum levels of Mmk, folic acid, tHcy, cobalamin, blood counts. Healthy patients served as controls for Mma. Vit B12 therapy – cyanocobalamin 1 mg iv. after HD every week for 6 weeks, after 6 weeks 1mg monthly. Results :HD patients: before B12 treatment after B12Methylmalonic acid 0,904 +/− 0,3890,554 +/− 0,222Total homocystein 21,653 +/− 6,85116,055 +/− 4,896Mma in EPO treated pts: 0,842 +/− 0,3250,536 +/− 0,234Mma in EPO non‐treated: 1,028 +/− 0,4820,590 +/− 0,199Healthy controls: Mma = 0,305 +/− 0,158 umol/l (max. norm. 0,22) Conclusions : We did not find overt vitamin B12 deficiency in HD pts, however elevated levels of Mma and tHcy raise a question about functional B12 deficiency. Vitamin B12 supplementation improved (decreased) the levels of both methylmalonic acid and homocystein in this subset of patients. Influence of EPO treatment merits further study.