5-Methyltetrahydrofolate Administration Is Associated with Prolonged Survival and Reduced Inflammation in ESRD Patients

Cianciolo, Giuseppe; Manna, Gaetano La; Colì, L.; Donati, Gabriele; D’Addio, Francesca; Persici, Elisa; Comai, Giorgia; Wratten, Marylou; Dormi, Ada; Mantovani, Vilma; Grossi, G.; Stefoni, Sergio

doi:10.1159/000142363

Cited by 39 publications

(43 citation statements)

References 56 publications

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“…In addition to folate, both vitamin B 6 and vitamin B 12 are necessary cofactors in Hcy metabolism [17]. Hcy is located at a branch-point of metabolic pathways: it is irreversibly degraded via the transsulfuration pathway to cysteine or it is remethylated back to methionine (Fig.…”

Section: Homocysteine and Fa Pathwaymentioning

confidence: 99%

“…In contrast, in a randomized prospective study performed on 341 HD patients, we failed to assess any role for baseline Hhcy and MTHFR polymorphism as independent risk factors for overall and cardiovascular mortality [17]. …”

Section: Hhcy and Cvd Risk In Esrd Patientsmentioning

confidence: 99%

“…We found an improvement in the survival rate of patients treated with 5-MTHF, although there was no difference in Hcy levels between the two groups of therapy [17]. …”

Section: Folate and Vitamin B: Interventional Studies On Cvd In Ckd Pmentioning

confidence: 99%

“…Although in healthy subjects tHcy levels may be significantly reduced by supplementation with folic acid (FA), vitamin B 12 , and vitamin B 6 , results of randomized clinical trials (RCTs) of patients with CVD have been largely disappointing because neither the occurrence of cardiovascular events nor mortality was found to be reduced by treatment with vitamins [12,13,14]. However, the possible involvement of tHcy as a cardiovascular and mortality risk factor in patients with ESRD is a matter of debate since various study designs (retrospective, prospective observational, and vitamin intervention studies, meta-analyses) have resulted in conflicting results [15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

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Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First

Cianciolo

Pascalis²,

Lullo

et al. 2017

Cardiorenal Med

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Background: Hyperhomocysteinemia (Hhcy) occurs in about 85% of chronic kidney disease (CKD) patients because of impaired renal metabolism and reduced renal excretion. Folic acid (FA), the synthetic form of vitamin B₉, is critical in the conversion of homocysteine (Hcy) to methionine. If there is not enough intake of FA, there is not enough conversion, and Hcy levels are raised. Summary: Hhcy is regarded as an independent predictor of cardiovascular morbidity and mortality in end-stage renal disease. Hhcy exerts its pathogenic action on the main processes involved in the progression of vascular damage. Research has shown Hhcy suggests enhanced risks for inflammation and endothelial injury which lead to cardiovascular disease (CVD), stroke, and CKD. FA has also been shown to improve endothelial function without lowering Hcy, suggesting an alternative explanation for the effect of FA on endothelial function. Recently, the role of FA and Hhcy in CVD and in CKD progression was renewed in some randomized trials. Key Messages: In the general population and in CKD patients, it remains a topic of discussion whether any beneficial effects of FA therapy are to be referred to its direct effect or to a reduction of Hhcy. While waiting for the results of confirmatory trials, it is reasonable to consider FA with or without methylcobalamin supplementation as appropriate adjunctive therapy in patients with CKD.

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Section: Homocysteine and Fa Pathwaymentioning

confidence: 99%

Section: Hhcy and Cvd Risk In Esrd Patientsmentioning

confidence: 99%

“…We found an improvement in the survival rate of patients treated with 5-MTHF, although there was no difference in Hcy levels between the two groups of therapy [17]. …”

Section: Folate and Vitamin B: Interventional Studies On Cvd In Ckd Pmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First

Cianciolo

Pascalis²,

Lullo

et al. 2017

Cardiorenal Med

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“…This is partly due to a case mix, with older and sicker patients presenting a high prevalence of comorbidities. Nevertheless, important limitations of current dialysis techniques emerge clearly with several uremic solutes inadequately removed even by the most sophisticated renal replacement therapies [1,2,3,4,5,6]. While we are struggling with these challenges, health care systems are fixing boundaries to the overall expenditure and budgets, being concerned about the growing costs of ESKD.…”

Section: Introductionmentioning

confidence: 99%

The Rise of Expanded Hemodialysis

Ronco

2017

Blood Purif

114

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The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility. Inner surface modification produced a reduction in membrane thrombogenicity and protein-membrane interaction with a less tendency to fouling and permeability decay. Further evolution in technology led to the development of a new class of membranes referred to as protein-leaking membranes or super-flux or high cutoff (HCO). These membranes are more permeable than conventional HF membranes and allow some passage of proteins, including albumin. The rationale for these membranes is the need for increased clearance of low molecular weight proteins and protein-bound solutes. However, albumin loss in protein-leaking HCO membranes represents a limitation whose effect in patients is still controversial. The last evolution in the field of membranes is the development of a new class defined as “high retention onset” (HRO) due to the peculiar high sieving value in the middle to high molecular weight range. The introduction of HRO membranes in the clinical routine has enabled the development of a new concept therapy called “expanded hemodialysis.” Its simple set up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.

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