Effects of High Dose Folate and Vitamin B12 on Hyperhomocysteinemia in Maintenance Hemodialysis Patients
Asian Journal of Research in Nephrology, Volume 5, Issue 3,
Background: A well-known risk factor for accelerated atherosclerosis in hemodialysis patients is hyperhomocysteinemia. In hemodialysis patients, folic acid and vitamin B12 have been administered singly or in combination to lower homocysteine (Hcy) levels.
Objectives: To evaluate the effect of high dose folate and vitamin B12, alone or in combination, on hyperhomocysteinemia in maintenance hemodialysis patients.
Methods: This is a prospective interventional study and conducted at the Department of Nephrology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study included 88 patients of maintenance hemodialysis with hyperhomocysteinemia. They were randomly distributed into four equal groups by lottery method, 22 patients who received only folic acid (FA), 15mg/day for a period of 8 weeks was considered as group I, 22 patients who received only Inj. vitamin B12, 1000 µg/4 weeks for a period of 8 weeks was considered as group II, 22 patients who received combination of folic acid (FA), 15mg/day and Inj. Vitamin B12, 1000µg/4 weeks for a period of 8 weeks was considered as group III and rest 22 patients who did not receive any intervention was considered as group IV (Control). Total plasma homocysteine, serum folate, and vitamin B12 levels were evaluated before and after intervention. The data were statistically analysed using window-based computer programme designed with Statistical Packages for Social Sciences (SPSS-22).
Results: The mean plasma total homocysteine (tHcy) at baseline was 32.52±8.68 (µmol/L) in group I, 31.45±9.94 (µmol/L) in group II, 33.29±11.08 (µmol/L) in group III, 31.61±6.87 (µmol/L) in group IV. The mean plasma tHcy at the end of 2nd month (post intervention) reduced to 26.45±6.23 (µmol/L) in group I, 27.38±7.63 (µmol/L) in group II and 21.72±6.91 (µmol/L) in group III and 29.98±7.05 (µmol/L) in group IV. The reduced plasma tHcy at the end of 2nd month was statistically significant (p=0.001) among four groups. The mean reduction (%) of tHcy was 18.7 in group I, 12.95 in group II, 34.76 in group III and 5.16 in group IV. The mean serum folic acid at the end of 2nd month was 22.94±6.62 (ng/ml) in group I, 6.68±1.9 (ng/ml) in group II, 25.03±5.18 (ng/ml) in group III and 7.35±1.87 (ng/ml) in group IV. The mean serum vitamin B12 at the end of 2nd month was 388.14±191.55 (pg/ml) in group I, 1120.8±204.4 (pg/ml) in group II, 1066.8±228.58 (pg/ml) in group III and 385±99.05(pg/ml) in group IV. The difference of serum folic acid and serum vitamin B12 at the end of 2nd month were statistically significant (p<0.05) among four groups.
Conclusion: High dose folate and vitamin B12, alone or in combination were effective in reducing homocysteine level in maintenance hemodialysis patients.
- vitamin B12
How to Cite
Pastore A, De Angelis S, Casciani S, Ruggia R, Di Giovamberardino G, Noce A, et al. Effects of folic acid before and after vitamin B12 on plasma homocysteine concentrations in hemodialysis patients with known MTHFR genotypes. Clin Chem. 2006;52(1):145-8.
DOI:10.1373/clinchem.2005.056119, PMID 16391331.
Manns B, Hyndman E, Burgess E, Parsons H, Schaefer J, Snyder F, et al. Oral vitamin B12 and high-dose folic acid in hemodialysis patients with hyper-homocyst (e) inemia. Kidney Int. 2001;59(3):1103-9.
Erkan S, Erkan D, Erce S, Ahmet Y. Effect of intravenous acetylcysteine on plasma homocysteine in hemodialysis patients. Hemoglobin (g/dL). 2008;10;1-42.
Massy ZA, Ceballos I, Chadefaux-Vekemens B, Nguyen-Khoa T, Descamps-Latscha B, Drüeke TB, et al. Homocyst (e) ine, oxidative stress, and endothelium function in uremic patients. Kidney Int. 2001;59:243-5.
Arnadottir M, Gudnason V, Hultberg B. Treatment with different doses of folic acid in haemodialysis patients: effects on folate distribution and aminothiol concentrations. Nephrol Dial Transplant. 2000;15(4):524-8.
Azadibakhsh N, Hosseini RS, Atabak S, Nateghiyan N, Golestan B, Rad AH. Efficacy of folate and vitamin B12 in lowering homocysteine concentrations in hemodialysis patients. Saudi J Kidney Dis Transpl. 2009;20(5):779-88.
Righetti M, Ferrario GM, Milani S, Serbelloni P, La Rosa L, Uccellini M, et al. Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients. Med Sci Monit. 2003;9(4):PI19-24. PMID 12709680.
Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ. 2002;325(7374):1202.
Selhub J. Homocysteine metabolism. Annu Rev Nutr. 1999;19(1):217-46.
Guttormsen AB, Ueland PM, Svarstad E, Refsum H. Kinetic basis of hyperhomocysteinemia in patients with chronic renal failure. Kidney Int. 1997; 52(2):495-502.
DOI: 10.1038/ki.1997.359, PMID 9264008.
Kluijtmans LA, Boers GH, Stevens EM, Renier WO, Kraus JP, Trijbels FJ, et al. Defective cystathionine beta-synthase regulation by S-adenosylmethionine in a partially pyridoxine responsive homocystinuria patient. J Clin Invest. 1996;98(2):285-9.
DOI: 10.1172/JCI118791, PMID 8755636.
Bostom AG, Shemin D, Lapane KL, Hume AL, Yoburn D, Nadeau MR, et al. High dose B-vitamin treatment of hyperhomocysteinemia in dialysis patients. Kidney Int. 1996;49(1):147-52. doi: 10.1038/ki.1996.19, PMID 8770960.
Brattström L, Israelsson B, Norrving B, Bergqvist D, Thörne J, Hultberg B, et al. Impaired homocysteine metabolism in early-onset cerebral and peripheral occlusive arterial disease effects of pyridoxine and folic acid treatment. Atherosclerosis. 1990;81(1):51-60.
DOI: 10.1016/0021-9150(90)90058-q, PMID 2407253.
Ubbink JB, Vermaak WJ, van der Merwe A, Becker PJ, Delport R, Potgieter HC. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr. 1994;124(10):1927-33.
Tremblay R, Bonnardeaux A, Geadah D, Busque L, Lebrun M, Ouimet D, et al. Hyperhomocysteinemia in hemodialysis patients: Effects of 12-month supplementation with hydrosoluble vitamins. Kidney Int. 2000;58(2): 851-8.
DOI: 10.1046/j.1523-1755.2000.00234.x, PMID 10916110.
Rocco MV, Makoff R. Appropriate vitamin therapy for dialysis patients. Semin Dial. 1997;10(5):272-7.
Kasama R, Koch T, Canals-Navas C, Pitone JM. Vitamin B6 and hemodialysis: The impact of high-flux/high-efficiency dialysis and review of the literature. Am J Kidney Dis. 1996;27(5):680-6.
DOI: 10.1016/s0272-6386(96)90103-1, PMID 8629628.
Bostom AG, Gohh RY, Liaugaudas G, Beaulieu AJ, Han H, Jacques PF, et al. Prevalence of mild fasting hyperhomocysteinemia in renal transplant versus coronary artery disease patients after fortification of cereal grain flour with folic acid. Atherosclerosis. 1999;145(1): 221-4.
DOI: 10.1016/s0021-9150(99)00023-4, PMID 10428313.
Sombolos K, Fragia T, Natse T, Bartholomatos G, Karagianni A, Katsaris G, et al. The effect of long-term intravenous high dose B-complex vitamins with or without folic acid on serum homocysteine in hemodialysis patients. J Nephrol. 2002;15(6):671-5.
Tayebi A, Biniaz V, Savari S, Ebadi A, Shermeh MS, Einollahi B, et al. Effect of vitamin B 12 supplementation on serum homocysteine in patients undergoing hemodialysis: A randomized controlled trial. Saudi J Kidney Dis Transpl. 2016;27(2):256-62.
DOI: 10.4103/1319-2442.178255, PMID 26997378.
Ossareh S, Shayan-Moghaddam H, Salimi A, Asgari M, Farrokhi F. Different doses of oral folic acid for homocysteine-lowering therapy in patients on hemodialysis: a randomized controlled trial. Iran J Kidney Dis. 2009;3(4):227-33. PMID 19841527.
Trimarchi H, Schiel A, Freixas E, Díaz M. Randomized trial of methylcobalamin and folate effects on homocysteine in hemodialysis patients. Nephron. 2002;91(1):58-63.
Naseri M, Sarvari GR, Esmaeeli M, Azarfar A, Rasouli Z, Moeenolroayaa G, et al. High doses of oral folate and sublingual vitamin B12 in dialysis patients with hyperhomocysteinemia. J Ren Inj Prev. 2016;5(3):134-9.
Sunder-Plassmann G, FÖDINGER M, Buchmayer H, Papagiannopoulos M, Wojcik J, Kletzmayr J, et al. Effect of high dose folic acid therapy on hyperhomocysteinemia in hemodialysis patients: results of the Vienna multicenter study. J Am Soc Nephrol. 2000; 11(6):1106-16.
Nakhoul F, Abassi Z, Plawner M, Khankin E, Ramadan R, Lanir N, et al. Comparative study of response to treatment with supraphysiologic doses of B-vitamins in hyperhomocysteinemic hemodialysis patients. Isr Med Assoc J. 2004;6(4):213-7. PMID 15115259.
Billion S, Tribout B, Cadet E, Queinnec C, Rochette J, Wheatley P, et al. Hyperhomocysteinaemia, folate and vitamin B12 in unsupplemented haemo dialysis patients: Effect of oral therapy with folic acid and vitamin B12. Nephrol Dial Transplant. 2002;17(3): 455-61.
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