Hyperhomocysteinemia and obesity represent risk factors for the development of atherosclerosis and chronic transplant nephropathy. In a prospective metabolic study, we monitored, over a period of 36 months, a total of 138 obese renal transplant recipients (body mass index ≥ 30 kg/m2) with hyperhomocysteinemia. We compared the findings of a new therapeutic regimen at 1 year (start of the study) and 3 years after renal transplantation. The new regimen consisted of a hypocaloric diet, corticoid withdrawal, folic acid (5 mg/day) and vitamin B6 (50 mg/day). During the follow-up period, significant decreases in total homocystein level (35.2 ± 12.4 μmol/l vs 14.7 ± 6.9 μmol/l, P < 0.01), body mass index (32.5 ± 3.2 kg/m2 vs 28.4 ± 2.8 kg/m2, P < 0.025) and triglycerides (3.8 ± 1.6 mmol/l vs 2.2 ± 1.2 mmol/l, P < 0.01) were noted. At the same time, serum levels of folate (17.8 ± 8.5 mg/l vs 32.9 ± 9.0 mg/l, P < 0.01) and vitamin B6 (5.4 ± 1.5 μg/l vs 9.3 ± 2.2 μg/l, P < 0.01) were increased. Creatinine clearance, proteinuria, mean blood pressure, lipoprotein(a) and apolipoprotein E isoform did not differ significantly. We conclude that hyperhomocysteinemia and obesity as risk factors after kidney transplantation can be effectively treated.

        Key words: atherosclerosis, hyperhomocysteinemia, hyperlipidemia, kidney transplantation, obesity.