Treatment of hyperhomocysteinemia in renal transplant recipients. A randomized, placebo-controlled trial.
BACKGROUND
Stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia, which is a risk factor for arteriosclerosis.


OBJECTIVE
To determine the effect of treatment with 1) vitamin B6 or 2) folic acid plus vitamin B12 on fasting and post-methionine-loading plasma total homocysteine levels in renal transplant recipients.


METHODS
Block-randomized, placebo-controlled, 2 x 2 factorial study.


METHODS
University-affiliated transplantation program.


METHODS
29 clinically stable renal transplant recipients.


METHODS
Patients were randomly assigned to one of four regimens: placebo (n = 8); vitamin B6, 50 mg/d (n = 7); folic acid, 5 mg/d, and vitamin B12, 0.4 mg/d (n = 7); or vitamin B6, 50 mg/d, folic acid, 5 mg/d, and vitamin B12, 0.4 mg/d (n = 7).


METHODS
Fasting and 2-hour post-methionine-loading plasma total homocysteine levels.


RESULTS
Vitamin B6 treatment resulted in a 22.1% reduction in geometric-mean post-methionine-loading increases in plasma total homocysteine levels (P = 0.042), and folic acid plus vitamin B12 treatment caused a 26.2% reduction in geometric-mean fasting plasma total homocysteine levels (P = 0.027). These results occurred after adjustment for age; sex; and pretreatment levels of total homocysteine, B vitamins, and creatinine.


CONCLUSIONS
Vitamin B6 should be added to the combination of folic acid and vitamin B12 for effective reduction of both post-methionine-loading and fasting plasma total homocysteine levels in renal transplant recipients.
Bostom
A G
AG
Jean Mayer USDA Human Nutrition Research Center, Boston, Massachusetts, USA.
Gohh
R Y
RY
Beaulieu
A J
AJ
Nadeau
M R
MR
Hume
A L
AL
Jacques
P F
PF
Selhub
J
J
Rosenberg
I H
IH
D004359:Drug Therapy, Combination; D005163:Factor Analysis, Statistical; D005492:Folic Acid / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008715:Methionine; D011736:Pyridoxine / Q000627:therapeutic use; D012307:Risk Factors; D014805:Vitamin B 12 / Q000627:therapeutic use
D006710:Homocysteine; D005492:Folic Acid; D008715:Methionine; D011736:Pyridoxine; D014805:Vitamin B 12