Efficacy of methylcobalamin on lowering total homocysteine plasma concentrations in haemodialysis patients receiving high-dose folic acid supplementation

Abstract

The benefit of methylcobalamin administration on lowering plasma tHcy levels in HD patients was remarkable. Our study suggested that both supplementations of high-dose folic acid and methylcobalamin are required for the remethylation pathway to regain its normal activity. This method could be a therapeutic strategy to combat the risk associated with atherosclerosis and cardiovascular disease in patients with chronic renal failure.

Pharmacological Dose of Vitamin B12 Is as Effective as Low-Dose Folinic Acid in Correcting Hyperhomocysteinemia of Hemodialysis Patients

“…[9,10,21] The mean baseline folic acid in our patients was as high as 14.7 ng/mL, close to the posttreatment level by folic acid supplement in some other studies. [22,23] This higher baseline folic acid level and lower baseline Hcy level might result in less decrease in our FNA group, which was also reported in the general population and uremic patients. [23] Some authors credited this higher baseline folic acid level to other sources of folic acid supplement than the prescription from the hemodialysis center; this would become more common after government policies to fortify the food supply with folic acid, such as in the United States.…”

“…[22,23] This higher baseline folic acid level and lower baseline Hcy level might result in less decrease in our FNA group, which was also reported in the general population and uremic patients. [23] Some authors credited this higher baseline folic acid level to other sources of folic acid supplement than the prescription from the hemodialysis center; this would become more common after government policies to fortify the food supply with folic acid, such as in the United States. [11] Another possible cause in Taiwan might be related to diet behavior.…”

“…Koyama et al reported that pharmacologic dose of methylcobalamin alone could lower Hcy by 18.7%, with a similar decrease (17.3%) by oral folic acid supplement in the same study. [23] Sombolos et al found a 27.3% rebound increase of Hcy after suspending intravenous Vit B12 supplementation for three months, despite a persistent high serum Vit B12. [27] A previous study suggested that IV pharmacologic dose of Vit B12 would work effectively only under folic acid supplementation.…”

“…[13,14,16] Up to a 60% reduction of Hcy had been reported when pharmacologic Vit B12 was given after every dialysis. [23] Therefore, it seems the maximal effect of pharmacologic dose of Vit B12 on Hcy-lowering could be achieved with the simultaneous supplement of folic acid. Recently, two randomized control studies failed to prove that lowering Hcy in advanced kidney disease could improve the cardiovascular mortality or event, [28,29] though some experts still supported to lower the Hcy in this population.…”

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