Association Between Adherence to Folic Acid Supplements and Serum Folate, and Plasma Homocysteine Among Hemodialysis Patients

Abstract

Objective-To examine the relationship between adherence to prescribed folic acid supplements and folic acid intake, serum folate and plasma homocysteine in hemodialysis patients. The effects of change in adherence patterns from enrollment to one year later on changes in these same measures were also assessed. Design-Secondary data analysisParticipants-Eighty six hemodialysis patients who participated in the Hemodialysis (HEMO) Study's Homocysteine ancillary study.Main Outcome Measures-Folic acid supplement intake, serum folate and plasma homocysteine.Results-Eighty-eight percent of patients at enrollment and 91% one year later were adherent to prescribed folic acid supplements. Non-adherers had lower intakes of folic acid at both enrollment Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. and one year later and lower serum folate levels at enrollment. Percent change was significantly different between the 3 adherence change groups for folic acid intake (p=0.001) and plasma homocysteine (p<0.001) from enrollment to one year later. The non-adherent group at enrollment had the lowest intakes and serum folate levels, and the highest plasma homocysteine levels. When they became adherent one year later, they had the greatest change in folic acid intake (5461%; p=0.03), coupled with a 69% increase in serum folate (p=0.04) and a 29% decrease in plasma homocysteine (p=0.03). NIH Public AccessConclusions-Hemodialysis patients who were non-adherent to folic acid supplement prescriptions had low folic acid intakes, low serum folates and high homocysteine levels. When their adherence improved, folic acid intakes rose, serum folates increased and plasma homocysteine levels decreased, although mild hyperhomocysteinemia persisted.

Methyl Donor Nutrients in Chronic Kidney Disease: Impact on the Epigenetic Landscape

“…The ability of folate to lower homocysteine levels indirectly suggests it might have a positive influence on CVD, considering that high homocysteine plasma levels are linked to cardiovascular mortality in CKD (7). Accordingly, HD patients display low folic acid intake, low folate serum levels and high homocysteine levels (44,48).…”

“…One possibility is that homocysteine is simply a marker of increased CVD risk and that SAH accumulation may be the cause of increased risk. Studies on atherosclerosis, CKD, diabetes and obesity have all shown that SAH levels better reflect an increased cardiovascular risk than homocysteine (48,49,52,53). One proposed mechanism is that SAH promotes apoptosis of endothelial cells, independently of homocysteine levels, and enhances Dihydronicotinamide-adenine dinucleotide phosphate (NADPH) oxidase expression, increasing the production of reactive oxygen species (50,54).…”

Effect of folic acid combined with pravastatin on arteriosclerosis in elderly hypertensive patients with lacunar infarction

“…The combined use of antihypertensive drugs and folic acid in patients with hypertension and elevated levels of Hcy can improve blood pressure control and reduce Hcy levels. [ 30 , 31 ] Pushpakumar et al [ 32 ] studied the protective effects of folic acid in hypertension and confirmed that folic acid supplementation has a protective effect on cardiovascular events in hypertension. Other studies, including experiments in rats, have shown that low-dose folic acid as a supplement can significantly reduce their Hcy, TC, and low-density lipoprotein concentrations and lower the incidence of atherosclerosis, suggesting that low-dose folic acid can be used as an atheroma and primary prevention of sclerosis in subjects with risk factors for atherosclerosis.…”

Maintained Folic Acid Supplementation Reduces the Risk of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

“…Thus, greater beneficial effect may be expected in patients with adequate duration of treatment of FA (≥34%). In addition, it has been reported that nonadherence to FA supplement results in irregular FA intakes and high homocysteine levels [29]. Therefore, improved adherence contributes to achievement of adequate duration of FA therapy.…”