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Article Review/Hyperlink
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Shemin D, Lapane KL, Hume Al, Yoburn D, Nadeau M, Bendich A,
Selhub J, Rosenberg IH
High dose B vitamin treatment of hyperhomocysteinemia in
dialysis patients
Kidney Int
(Jan) 49:147-152 1996

Several investigators have demonstrated that moderate hyperhomocysteinemia
in the general population is an independent risk factor for premature
vascular disease in coronary, cerebrovascular and peripheral vessel
beds. Homocysteine levels are markedly elevated in chronic dialysis
patients and also appear to confer an increased risk of vascular
disease. Patients with normal renal function can usually normalize
homocysteine levels with folic acid supplementation in the range of 0.6
to 5 mg per day. In the study by Bostom et al., chronic maintenance
dialysis patients were randomly assigned to receive either placebo or
supraphysiologic doses of folate (15 mg/day), vitamin B6 (100 mg/day) and
vitamin B12 (1 mg/day). All patients received standard supplementation
consisting of 1 mg of folic acid, 10 mg of vitamin B6 and 12 ug of
vitamin B12.
In the active treatment group, total homocysteine levels decreased from
29.5 umol/liter at baseline to 20.7 umol/liter at four weeks (29.8%
decrease from baseline) and 21.9 umol/liter at eight weeks (25.8% decrease
from baseline). In addition, there were increases in plasma folate
(2077%), pyridoxal 5'-phosphate (the active metabolic form of vitamin B6,
173%) and vitamin B12 (188%) levels that were indicative of adequate
compliance with the treatment protocol. Neither homocysteine nor plasma
vitamin levels changed significantly in the placebo group during the
trial. There was not a significant increase in the incidence of side
effects or in serum creatinine or liver transaminase levels in the active
treatment group.
Despite the decrease in total homocysteine levels in the active treatment
group, only three of twelve patients with a baseline total homocysteine
level greater than 20 umol/liter had a decrease in their homocysteine
level to within the normal range (less than 15 umol/liter). Further studies
are needed to determine the safety and efficacy of doses of folate in excess
of 15 mg/day for the normalization of homocysteine elevels in dialysis
patients. (Michael V. Rocco,
M.D., Bowman Gray School of Medicine)
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