Response of hyperhomocysteinemia to folic acid supplementation in patients with end-stage renal disease
Dierkes, J.; Domröse, U.; Ambrosch, A.; Bosselmann, H.P.; Neumann, K.H.; Luley, C.
Clinical Nephrology 51(2): 108-115
1999
ISSN/ISBN: 0301-0430 PMID: 10069646 Document Number: 511861
A high prevalence of hyperhomocysteinaemia is found in patients with end-stage renal disease (ESRD). Since these patients are also at increased risk for vitamin deficiency, a supplementation study comparing two doses of folic acid was performed in patients with ESRD treated with maintenance haemodialysis or with peritoneal dialysis. Patients undergoing haemodialysis (n = 70) or peritoneal dialysis (n = 12) were supplemented with 2.5 mg or 5 mg folic acid (three times per week after each dialysis treatment) for four weeks in a parallel study design. In 20 haemodialysis patients, the effect of folic acid withdrawal was observed after four weeks. Both supplementation schemes reduced homocysteine to a similar extent (35%) but did not normalize homocysteine concentrations in the majority of patients. Dialysis also had a strong homocysteine lowering effect. After supplementation, 74% of the haemodialysis patients had post-dialysis homocysteine concentrations within the reference range (< 16 micro mol/litre). Homocysteine concentrations remained decreased in 20 patients four weeks after withdrawal of folic acid supplementation. It is concluded that supplementation with 2.5 or 5 mg folic acid has a similar effect on homocysteine concentrations to supplementation regimens using 15 mg folic acid supplements. In contrast to the effect of folic acid supplementation in subjects with normal renal function, folic acid supplementation does not normalize homocysteine concentrations in ESRD patients.