Effective homocysteine-lowering vitamin B treatment in peritoneal dialysis patients.
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.
Righetti
Marco
M
Division of Nephrology and Dialysis, Vimercate Hospital, Vimercate, Italy. nediavim@libero.it
Tommasi
Adalberto
A
Lagona
Cinzia
C
La Rosa
Lucia
L
Uccellini
Mario
M
Sessa
Adalberto
A
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*
D006710:Homocysteine; D014803:Vitamin B Complex