title: High dose-B-vitamin treatment of hyperhomocysteinemia in dialysis patients.
abstract: Hyperhomocysteinemia, an arteriosclerotic risk factor, persists in 75% of dialysis patients despite routine low dose supplementation with the B-vitamin co-factors/substrates for homocysteine (Hcy) metabolism, and normal or supernormal plasma status of these vitamins (Atherosclerosis 114:93, 1995). We conducted a placebo-controlled eight-week trial of the effect on plasma homocysteine of adding supraphysiologic dose folic acid (15 mg/day), B-6 (100 mg/day), and B-12 (1 mg/day) to the usual daily dosing of 1 mg folic acid, 10 mg B-6, and 12 micrograms B-12, in 27 hyperhomocysteinemic dialysis patients. Total plasma homocysteine was measured at baseline, and after four and eight weeks. Blinded analyses revealed no evidence of toxicity in the group randomized to supraphysiologic dose B-vitamin supplementation. Plasma homocysteine was significantly reduced after both four weeks (-29.8% vs. -2.0%; P = 0.0024) and eight weeks (-25.8% vs. +0.6%; P = 0.0009) of active versus placebo treatment. Also, 5 of 15 treated versus 0 of 12 placebo group patients had their plasma Hcy reduced to within the normative range (< 15 mumol/liter). Supraphysiologic doses of B-vitamins may be required to correct hyperhomocysteinemia in dialysis patients.
authors.affiliation: USDA Human Nutrition Research Center on Aging, Tufts New England Medical Center, Boston, Massachusetts, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Bostom
authors.forename: D
authors.initials: D
authors.lastname: Shemin
authors.forename: K L
authors.initials: KL
authors.lastname: Lapane
authors.forename: A L
authors.initials: AL
authors.lastname: Hume
authors.forename: D
authors.initials: D
authors.lastname: Yoburn
authors.forename: M R
authors.initials: MR
authors.lastname: Nadeau
authors.forename: A
authors.initials: A
authors.lastname: Bendich
authors.forename: J
authors.initials: J
authors.lastname: Selhub
authors.forename: I H
authors.initials: IH
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016022:Case-Control Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000628:therapy; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D014803:Vitamin B Complex / Q000008:administration & dosage*
chemical_list: D006710:Homocysteine; D014803:Vitamin B Complex