Journal Article

Difference in the homocysteine‐lowering effect of folic acid in haemodialysis patients with and without occlusive vascular disease

Eric Descombes, Olivier Boulat, Louis‐Félix Bersier and Gilbert Fellay

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 16, issue 3, pages 585-589
Published in print March 2001 | ISSN: 0931-0509
Published online March 2001 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/16.3.585
Difference in the homocysteine‐lowering effect of folic acid in haemodialysis patients with and without occlusive vascular disease

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Background. Hyperhomocysteinaemia has been identified as an independent cardiovascular risk factor and is found in more than 85% of patients on maintenance haemodialysis. Previous studies have shown that folic acid can lower circulating homocysteine in dialysis patients. We evaluated prospectively the effect of increasing the folic acid dosage from 1 to 6 mg per dialysis on plasma total homocysteine levels of haemodialysis patients with and without a history of occlusive vascular artery disease (OVD).

Methods. Thirty‐nine stable patients on high‐flux dialysis were studied. Their mean age was 63±11 years and 17 (43%) had a history of OVD, either coronary and/or cerebral and/or peripheral occlusive disease. For several years prior to the study, the patients had received an oral post‐dialysis multivitamin supplement including 1 mg of folic acid per dialysis. After baseline determinations, the folic acid dose was increased from 1 to 6 mg/dialysis for 3 months.

Results. After 3 months, plasma homocysteine had decreased significantly by ≈23% from 31.1±12.7 to 24.5±9 μmol/l (P=0.0005), while folic acid concentrations had increased from 6.5±2.5 to 14.4±2.5 μg/l (P<0.0001). However, the decrease of homocysteine was quite different in patients with and in those without OVD. In patients with OVD, homocysteine decreased only marginally by ≈2.5% (from 29.0±10.3 to 28.3±8.4 μmol/l, P=0.74), whereas in patients without OVD there was a significant reduction of ≈34% (from 32.7±14.4 to 21.6±8.6 μmol/l, P=0.0008). Plasma homocysteine levels were reduced by >15% in three patients (18%) in the group with OVD compared with 19 (86%) in the group without OVD (P=0.001), and by >30% in none of the patients (0%) in the former group compared with 13 (59%) in the latter (P=0.001).

Conclusions. These results indicate that the homocysteine‐lowering effect of folic acid administration appears to be less effective in haemodialysis patients having occlusive vascular disease than in those without evidence of such disease.

Keywords: cardiovascular disease; folic acid; haemodialysis; homocysteine; vitamins

Journal Article.  3157 words. 

Subjects: Nephrology

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