Response of Hyperhomocysteinemia to Folic Acid Supplementation in Hemodialysis Patients

Lee, Seung Il; Chung, Jong Hoon

Abstract

BACKGROUND: Hyperhomocysteinemia is a common finding in patients with end-stage renal disease and has been recognized as an independent risk factor for atherosclerotic disease in the coronary, cerebral, and peripheral vasculature. Although treatment with folic acid is known to be effective method for decreasing plasma homocysteine of hemodialysis patients in many studies, there are no controlled data for long term treatment. The present study is aimed to assess clinical response of folic acid administration for 12 weeks.
METHODS
38 patients undergoing hemodilaysis were supplemented with 5 mg folic acid daily for 12 weeks and were observed for next 12 weeks after stopping folic acid. We measured plasma homocysteine and folic acid concentration every 2 weeks during treatment and every 4 week for next 12 weeks after stopping folic acid.
RESULTS
Baseline Plasma homocysteine concentration in hemodialysis patients was higher than normal control. In hemodialysis paient with folic acid administrtion(5 mg/day), significant decrease in plasma homocysteine concentration was noted after 2 week(27.8%, p<0.005) and normalization of plasma homocysteine concentration was noted in 14 of 38 patient(37%) at 12 weeks. After stopping folic acid, plasma homocycteine concentration increased to baseline concentration at 8 weeks. There were no significant complications except mild nausea, vomiting during treatment.
CONCLUSION
These result indicate that relatively long term treatment of 5 mg daily folic acid in hemodialysis patient cause a more normalization of plasma homocysteine concentration than other short term studies.