Reduced, free and total fractions of homocysteine and other thiol compounds in plasma from patients with renal failure.

The levels of different fractions of homocysteine, cysteine and cysteinylglycine were investigated in 17 patients on chronic hemodialysis, 9 patients with reduced renal function and 4 patients with nephrotic syndrome and compared with 14 healthy subjects. Total plasma homocysteine, cysteine and cysteinylglycine were increased in the patients with reduced renal function and in those on chronic hemodialysis. The free (non-protein-bound) forms of plasma homocysteine and cysteine were significantly increased in all groups of patients. The reduced forms of plasma homocysteine and cysteine were, however, not increased in any of the patient groups; on the contrary, reduced plasma homocysteine was significantly decreased in the group of patients with reduced renal function. These findings indicate that the plasma levels of reduced forms of the thiol compounds are relatively normal and do not merely mirror the elevation of the disulfide forms. The possible relation between homocysteine and increased atherogenesis in patients with renal failure is discussed.