Increased Homocysteine in Liver Cirrhosis: A Result of Renal Impairment?

Abstract

In their recent publication, Ferre et al. (1) investigated homocysteine concentrations in 76 patients with liver cirrhosis. The majority of these patients suffered from alcoholic liver disease (63%). The authors described significantly increased homocysteine in nonabstaining alcoholic patients with cirrhosis. Furthermore, the homocysteine concentrations were inversely correlated with the severity of the liver disease (Child–Pugh score) and with the folate concentrations in these patients. The authors proposed that the homocysteine concentration was influenced by alcohol intake and by the degree of liver impairment. The authors conclude that nonnutritional factors may affect homocysteine concentrations. Hyperhomocysteinemia also occurs in patients with decreased renal function, but the investigators provided no information about the renal function of these patients. Renal function is considerably reduced in patients with compensated cirrhosis (2). An inverse relationship between the glomerular filtration rate (GFR) and plasma homocysteine has been noted, and declining renal function is associated with higher plasma homocysteine concentrations (3). We studied 23 patients with liver cirrhosis (median age, 54 years; range, 20–68 years; 16 males, … [↵][1]bAddress correspondence to this author at: Centre de Recerca Biomedica, Hospital Universitari de Sant Joan, C/. Sant Joan s/n, 43201-Reus, Catalunya, Spain. Fax 34-977-312569; e-mail jcamps{at}grupsgs.com. [1]: #xref-corresp-2-1