Plasma homocysteine and total antioxidant status in diabetic chronic kidney disease and diabetic renal allograft recipients: effect of folic acid therapy


  • Pooja C. Wadwa Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Jashan Sandhu
  • Jasvinder S. Sandhu Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Gurcharan L. Avasthi
  • Navjot Bajwa
  • P. M. Sohal



Diabetic chronic kidney disease, Renal allograft recipients, Type 2 diabetes mellitus


Background: 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.


Selhub J. Homocysteine metabolism. Annu Rev Nutr. 1999;19:217-46.

Jacobs RL, House JD, Brosnan ME,Brosnan JT. Effects of streptozotocin-induced diabetes and of insulin treatment on homocysteine metabolism in the rat. Diabetes. 1998;47(12):1967-70.

Drzewoski J, Czupryniak L, Chwatko G,Bald E. Hyperhomocysteinemia in poorly controlled type 2 diabetes patients. Diabetes Nutr Metab. 2000;13(6):319-24.

Friedman AN, Bostom AG, Selhub J, Levey AS,Rosenberg IH. The kidney and homocysteine metabolism. J Am Soc Nephrol. 2001;12(10):2181-9.

Desouza C, Keebler M, McNamara DB,Fonseca V. Drugs affecting homocysteine metabolism: impact on cardiovascular risk. Drugs. 2002;62(4):605-16.

Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K, et al. Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India. Eur J Nutr. 2002;41(2):68-77.

Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet. 2000;356(9226):279-84.

Bhargava S, Ali A, Bhargava EK, Manocha A, Kankra M, Das S, et al. Lowering homocysteine and modifying nutritional status with folic acid and vitamin B(12) in Indian patients of vascular disease. J Clin Biochem Nutr. 2012;50(3):222-6.

Elias AN, Eng S. Homocysteine concentrations in patients with diabetes mellitus--relationship to microvascular and macrovascular disease. Diabetes Obes Metab. 2005;7(2):117-21 9.

Davies L, Wilmshurst EG, McElduff A, Gunton J, Clifton-Bligh P,Fulcher GR. The relationship among homocysteine, creatinine clearance, and albuminuria in patients with type 2 diabetes. Diabetes Care. 2001;24(10):1805-9.

Oishi K, Nagake Y, Yamasaki H, Fukuda S, Ichikawa H, Ota K, et al. The significance of serum homocysteine levels in diabetic patients on haemodialysis. Nephrol Dial Transplant. 2000;15(6):851-5.

Li J, Shi M, Zhang H, Yan L, Xie M, Zhuang L, et al. Relation of homocysteine to early nephropathy in patients with Type 2 diabetes. Clin Nephrol. 2012;77(4):305-10.

Friedman AN, Rosenberg IH, Selhub J, Levey AS,Bostom AG. Hyperhomocysteinemia in renal transplant recipients. Am J Transplant. 2002;2(4):308-13.

Einollahi B, Lessan-Pezeshki M, Kalantar E, Rostami Z, Khalili N, Ghadiani MH, et al. Hyperhomocysteinemia after kidney transplantation. Transplant Proc. 2011;43(2):586-7.

Wotherspoon F, Laight DW, Turner C, Meeking DR, Allard SE, Munday LJ, et al. The effect of oral folic acid upon plasma homocysteine, endothelial function and oxidative stress in patients with type 1 diabetes and microalbuminuria. Int J Clin Pract. 2008;62(4):569-74.

Aghamohammadi V, Gargari BP,Aliasgharzadeh A. Effect of folic acid supplementation on homocysteine, serum total antioxidant capacity, and malondialdehyde in patients with type 2 diabetes mellitus. J Am Coll Nutr. 2011;30(3):210-5.

Maxwell SR, Thomason H, Sandler D, Leguen C, Baxter MA, Thorpe GH, et al. Antioxidant status in patients with uncomplicated insulin-dependent and non-insulin-dependent diabetes mellitus. Eur J Clin Invest. 1997;27(6):484-90.

Rochette L, Zeller M, Cottin Y,Vergely C. Diabetes, oxidative stress and therapeutic strategies. Biochim Biophys Acta. 2014;1840(9):2709-29.






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