RESUMO
Indian population is usually deficient in folic acid. Aim was to study the plasma homocysteine and antioxidant status in type 2 diabetics and healthy individuals before and after folate therapy. Methods: This study was done in four groups of 25 cases each. These included: type 2 diabetics with end stage diabetic chronic kidney disease (CKD) (group A); diabetic renal allograft recipients with normal and stable graft function (group B); uncomplicated type 2 diabetics (group C); and age and sex matched healthy controls (group D). The serum homocysteine and total antioxidant status (TAS) were measured at baseline and after 4 weeks of folate therapy. Results: The plasma homocysteine levels were 18.163.80, 16.150.66, 12.480.82 and 23.361.61 mol/L in group A, B, C and D respectively. The homocysteine levels were significantly low in all diabetic groups when compared to healthy controls. The plasma homocysteine were significantly elevated in stage 5 diabetic CKD and diabetic renal transplant recipients as compared to uncomplicated diabetics. After four weeks of folate therapy, there was a significant decrease of homocysteine in all the groups. The mean values of TAS were 1.42 0.18, 1.49 0.18, 1.17 0.06 and 1.60 0.86 pg/ml in group A, B, C and D respectively. There was no significant correlation between diabetic groups and healthy controls. No change was observed in TAS levels after folate therapy. Conclusions: Our results show significant hyperhomocysteinemia in healthy Indians. Plasma homocysteine were significantly low in all diabetic groups as compared to healthy individuals. We suggest supplementation of Indian diet with folic acid.
RESUMO
Calcium channel blockers are used for the management of hypertension or heart disease after organ transplantation and are known to increase in blood cyclosporine A(CsA) levels through an effect on the hepatic cytochrome P450 system resulting in reduced CsA clearance. Authors reviewed and analyzed 154 CsA-treated renal allograft recipients at Yeungnam University Hospital from Mar. 1985 to Mar. 1996 to evaluate the effects of calcium antagonists on renal recipient. Among 154 recipients, 60 recipients were received triple immunosuppressive drugs (CsA+Prednisolone+ Azathioprine) only (Control group), 43 recipients with diltiazem (D group) and 51 recipients with Nifedipine (N group). Blood pressure(systolic and diastolic), creatinine level, CsA blood level and CsA dose had been checked at 1 week, 1, 3, 6, 9 and 12 months, after renal transplantation serially and compared the results with each groups. CsA blood levels of all groups had been adjusted to 100-150 ng/ml after 3 month of immunosuppression. There was no difference in CsA blood levels among 3 groups at all follow-up periods. Dose reduction of CsA had been noted 18%, 27%, 29%, 32%, and 28% in D group at 1, 3, 6, 9 and 12 months respectively(p0.05). Incidence of primary nonfunction, graft loss, acute rejection, chronic rejection and CsA nephrotoxicity were not different statistically among 3 groups. In conclusion, the use of diltiazem was associated with a markedly reduced requirement for CsA without any adverse effect on graft function or graft outcome. but the use of nifedipine may not associated with repuirement for CsA statistically.