Plasma Homocysteine, Vitamin B&lt;sub&gt;6&lt;/sub&gt;, Vitamin B&lt;sub&gt;12&lt;/sub&gt; and Folic Acid in End-Stage Renal Disease during Low-Dose Supplementation with Folic Acid

Hong, Sae‐Yong; Yang, Dong-Ho; Chang, Sung-Keun

doi:10.1159/000013378

Cited by 25 publications

(15 citation statements)

References 12 publications

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“…In contrast to studies on adult dialyzed patients where high folate concentrations were found due to supplementation [27,28], in this study supplementation was not routine and we found no difference in folate status and vitamin B 12 concentration in dialyzed and nondialyzed patients.…”

Section: Discussioncontrasting

confidence: 99%

Plasma homocysteine concentration in children with chronic renal failure

Mérouani¹,

Lambert²,

Delvin

et al. 2001

Pediatric Nephrology

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Hyperhomocysteinemia, a risk factor for vascular disease, is commonly found in adult patients with end-stage renal disease. Major determinants of elevated plasma homocysteine levels in these patients include deficiencies in folate and vitamin B12, methylenetetrahydrofolate reductase (MTHFR) genotype and renal function. Little information is available for children with chronic renal failure (CRF). The prevalence and the factors that affect plasma homocysteine concentration were determined in children. Twenty-nine children with various degrees of CRF (15 were dialyzed, 14 were not dialyzed) were compared with 57 age- and sex-matched healthy children. Homocysteine concentrations were higher in patients than controls (17.3 micromol/l vs 6.8 micromol/l, P<0.0001) and hyperhomocysteinemia (>95th percentile for controls: 14.0 micromol/l) was seen in 62.0% of patients and 5.2% of controls. Folate concentrations were lower in patients (9.9 nmol/l) than controls (13.5 nmol/l), P<0.01. Vitamin B12 was similar in patients (322 pmol/l) and controls (284 pmol/l). Dialyzed patients have a higher prevalence of hyperhomocysteinemia than nondialyzed patients (87% vs 35%). Dialyzed patients with MTHFR mutation have higher plasma homocysteine (28.5 micromol/l) than nondialyzed patients with the mutation (10.7 micromol/l), P<0.002. In our study, differences between controls and patients in plasma homocysteine concentrations are observed when age is greater then 92 months, folate less than 21.6 nmol/l and vitamin B12 less than 522 pmol/l. Our study shows that hyperhomocysteinemia is common in children with CRF and is associated with low folate and normal vitamin B12 status, compared to normal children. Among the patients, the dialyzed patients with the MTHFR mutation are particularly at risk for hyperhomocysteinemia. Further studies are needed to investigate therapeutic interventions and the potential link with vascular complications in these patients.

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Section: Discussioncontrasting

confidence: 99%

Plasma homocysteine concentration in children with chronic renal failure

Mérouani¹,

Lambert²,

Delvin

et al. 2001

Pediatric Nephrology

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“…In agreement with our results, Merouani et al [30]found higher levels of Hcy in dialysis patients than those on conservative treatment, whereas Hong et al [32]did not find any significant difference.…”

Section: Discussionsupporting

confidence: 93%

“…Also, Hong et al [32]reported that serum folic acid concentrations were 3–4 times higher in the dialysis than the predialysis group, but these levels of folic acid were not enough to reduce hyperhomocysteinemia present in ESRD patients. So, hyperhomocysteinemia in ESRD may not be due to quantitative deficiency in folic acid and vitamin B 12 , but it could be due to impaired performance of folic acid/vitamin B 12 -dependent metabolic process and/or altered metabolism or inhibition of intracellular vitamin activity [14].…”

Section: Discussionmentioning

confidence: 99%

Study of the Homocysteine Status in Children with Chronic Renal Failure

Farid

Faheem²,

Heshmat³

et al. 2004

Am J Nephrol

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Background/Aims: Vascular diseases are a major cause of morbidity and mortality in end-stage renal disease (ESRD) patients and they cannot be explained entirely by the prevalence of traditional risk factors for atherosclerosis. The role of hyperhomocysteinemia as an additional risk factor in the development of accelerated atherosclerosis and/or thrombosis in these patients has been suggested possibly due to homocysteine (Hcy) induced endothelial cell injury. This study was aimed at evaluation of the Hcy status in children with chronic renal failure (CRF) especially in those suffering from ESRD and the possible role of folic acid and vitamin B₁₂ therapy in the correction of hyperhomocysteinemia if present. Methods: This study included 40 patients with CRF, 30 on regular hemodialysis (HD) treatment (group I) and 10 on conservative (medical) treatment (group II) in comparison to 20 healthy age- and sex-matched controls (group III). The basal serum levels of Hcy, folic acid and vitamin B₁₂ as well as plasma level of activated protein C resistance (APC-R) were measured in patients and controls. Results: The mean serum Hcy was significantly higher in those on regular HD (17.9 ± 10.07 µmol/l) in comparison to those on conservative treatment (8.05 ± 2.99 µmol/l) (p < 0.001) and controls (7.07 ± 2.24 µmol/l) (p < 0.001), while there was no significant variation between the latter two groups. The mean values of APC-R, folic acid and vitamin B₁₂ failed to show any significant difference in the three studied groups. No significant difference in the basal Hcy level between patients with previous history of vaso-occlusive disease and those without was found. Half of the patients on regular HD (group Ia) (n = 15) were given folic acid as 50 mg of 5-formyl-tetrahydrofolate (the active form of folic acid) intravenously once weekly after the dialysis session for 4 weeks. The other half (group Ib) (n = 15) received in addition to folic acid therapy, vitamin B₁₂ 1,000 µg hydroxycobalamine once intramuscularly. After therapy the mean Hcy decreased significantly in those who received folic acid and vitamin B₁₂ (7.80 ± 3.77 µmol/l) (p < 0.001) to a level comparable to the basal levels in conservative and control groups, whereas a non-significant decrease was found in those who received folic acid only (13.3 ± 11.47 µmol/l) (p > 0.05). Conclusions: Hcy is high in children with ESRD on regular HD and combined therapy of the active form of folic acid and vitamin B₁₂ is of value in decreasing Hcy values comparable to that in controls.

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“…Supplementation studies in dialysis patients hâve shown that increased intake of folate and vitamin B p reduced the homocysteine level but did not normalize it. 22 Moreover, a study conducted in a Chinese population reported similar sérum vitamin B p and higher sérum folate levels in hyperhomocysteinemia compared with control subjects, 26 indicating that high folate and cobalamin status is not always associated with a low homocysteine level.…”

Section: Discussionmentioning

confidence: 99%

“…In dialysis patients, the déterminants of homocysteine levels were reported to be plasma vitamin B 6 , B 12 , and folate levels, and also sérum creatinine and albumin levels. [20][21][22][23] Récent studies showed that a high homocysteine level in rénal failure patients is an independent risk factor for vascular complications and that this risk rises with increasing plasma homocysteine levels. 2425 By using the new FPIA assay, we confirmed a marked increase in homocysteine levels in thèse patients that has been reported with measurement by HPLC.…”

Section: Discussionmentioning

confidence: 99%