title: Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients.
abstract: BACKGROUND
  Cardiovascular disease is the most important cause of morbidity and mortality in hemodialysis patients. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Treatment with folate, B6 and B12 partially reduces hyperhomocysteinemia. We conducted a long-term study to evaluate whether 15 mg is more effective than 5 mg oral folic acid as a daily dosage to decrease hyperhomocysteinemia, and to assess whether homocysteine-lowering treatment reduces the risk of cardiovascular disease in hemodialysis patients.
  
  
  METHODS
  In a 1-year prospective randomised trial, 81 chronic hemodialysis patients, matched for age, gender and dialytic age, were divided into three groups: 30 untreated patients, 26 patients receiving 5 mg per day, and 25 patients receiving 15 mg per day.
  
  
  RESULTS
  There was a significant reduction in hyperhomocysteinemia over time in treated patients as compared to untreated, but there were no significant differences between the two treated groups. Only 12% of the treated patients reached normal total homocysteine plasma levels. We observed a trend towards a significant difference in survival rate in cardiovascular morbidity between treated and untreated patients. Furthermore, hemodialysis patients with new vascular events showed higher homocysteine levels than patients without events.
  
  
  CONCLUSIONS
  High-dose folic acid treatment did not improve outcome in hyperhomocysteinemia, and 88% of treated patients maintained higher than normal homocysteine levels. There was a trend towards a decreased rate of cardiovascular events in treated participants as compared to untreated ones.
authors.affiliation: Division of Nephrology and Dialysis, Vimercate Hospital, Vimercate, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Righetti
authors.forename: Gian M
authors.initials: GM
authors.lastname: Ferrario
authors.forename: Silvana
authors.initials: S
authors.lastname: Milani
authors.forename: Paola
authors.initials: P
authors.lastname: Serbelloni
authors.forename: Lucia
authors.initials: L
authors.lastname: La Rosa
authors.forename: Mario
authors.initials: M
authors.lastname: Uccellini
authors.forename: Adalberto
authors.initials: A
authors.lastname: Sessa
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate / Q000639:trends
chemical_list: D005492:Folic Acid