Homocysteine, folic acid and vitamin B12 in children with chronic kidney disease

Сardiovascular disease (CVD) is the main cause of the life expectancy reduction in patients with chronic kidney disease (CKD). Endothelial dysfunction (ED) plays a pivotal role in the pathogenesis of CVD. A significant contribution to the development of ED is made by hyperhomocysteinemia. The aim of the study was to assess the prevalence and severity of hyperhomocysteinemia, folic acid (FA), and vitamin B12 deficiency in children with stage 1-5 CKD, as well as to identify the relationship between these factors. Materials and methods: Serum concentrations of homocysteine, FA, and vitamin B12 were assayed in 112 children with CKD stage 1-5 aged from 3.5 months to 17 years 11 months, followed at the Center for Gravitational Blood Surgery and Hemodialysis of St. Vladimir Children's Clinical Hospital in 2021-2022. Results: hyperhomocysteinemia was detected in 51,8% of children with CKD, suboptimal serum concentrations of FA and vitamin B12 were found in 28,6% and 7,1% of patients, respectively. The median serum levels of homocysteine were significantly lower in the group of children with stage 1 CKD, with no significant difference between the groups of stage 2-5 CKD. There was a positive correlation of serum homocysteine concentration with the stage of CKD (ρ=0.300, p=0.002), and negative correlations of homocysteine and vitamin B12 levels (ρ=-0.485, p<0.0001), homocysteine and FA (ρ=-0.394, p<0.0001). Serum homocysteine concentration was significantly higher in children with FA deficiency (Me, Q1-Q3: 20.0 (14.1-28.9) µmol/l vs 11.0 (8.0-14.0) µmol/l, p<0.0001), and significantly lower in children receiving FC supplement (9.9 (7.0-13.4) µmol/l vs 13.1 (9.8-20.5) µmol/l, p=0.014). Conclusion: The inverse relationship of serum homocysteine concentration with FA and vitamin B12, the lower level of homocysteine in children receiving FA confirms the role of these vitamins in the prevention of hyperhomocysteinemia and emphasizees the importance of adequate provision of them to children with CKD.

дети, хроническая болезнь почки, гомоцистеин, витамин B12, фолиевая кислота, children, chronic kidney disease, homocysteine, vitamin B12, folic acid

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