title: Effective homocysteine-lowering vitamin B treatment in peritoneal dialysis patients.
abstract: BACKGROUND
  Hyperhomocysteinemia, a risk factor for atherosclerosis, is frequently detected in patients with renal failure. Vitamin B supplementation reduces but rarely normalizes homocysteine (Hcy) levels in hemodialysis patients. There are no data about the effects of vitamin B therapy on Hcy levels in patients on peritoneal dialysis (PD).
  
  
  OBJECTIVE
  We performed this trial both to observe baseline plasma Hcy levels in PD patients and to assess the effects of vitamin B therapy on Hcy levels in continuous ambulatory PD patients.
  
  
  METHODS
  We conducted a 6-month prospective study of the effects of vitamin B therapy on plasma Hcy levels. Biochemical analyses were obtained at baseline and after every phase of treatment with folic acid, folic acid plus vitamin B12, and folic acid plus vitamin B12 plus vitamin B6. Eighteen of the 25 enrolled patients finished the study.
  
  
  RESULTS
  Hyperhomocysteinemia was present in 83% of PD patients. We detected a trend toward a significant inverse relationship between baseline Hcy and folate levels. There were no significant correlations between baseline Hcy and vitamin B12, peritoneal membrane permeability, dialytic efficiency, or computed peritoneal Hcy clearance. We obtained an effective decrease in mean Hcy concentration from 20 to 14.8 micromol/L after folic acid and vitamin B12 treatment. We observed a further reduction in mean Hcy level to 12.8 micromol/L using the triple therapy; 72% of patients normalized their Hcy value.
  
  
  CONCLUSIONS
  High doses of folic acid, vitamin B6, and vitamin B12 normalize Hcy values in the majority of PD patients. This treatment may be important in reducing cardiovascular morbidity and mortality.
authors.affiliation: Division of Nephrology and Dialysis, Vimercate Hospital, Vimercate, Italy. nediavim@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Righetti
authors.forename: Adalberto
authors.initials: A
authors.lastname: Tommasi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Lagona
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: D000284:Administration, Oral; D000368:Aged; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D006710:Homocysteine / Q000097:blood* / Q000187:drug effects*; D006801:Humans; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D006710:Homocysteine; D014803:Vitamin B Complex