Folic acid supplementation in end-stage renal disease patients reduces total mortality rate.
BACKGROUND
Patients with end-stage renal disease (ESRD) are at high risk of cardiovascular disease and elevated serum homocysteine levels. Although folic acid supplementation has been documented to reduce serum homocysteine levels in ESRD patients, most trials of folic acid therapy for reducing cardiovascular diseases in ESRD patients have failed, mainly because of limited patient numbers.


METHODS
We used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a matched-pair retrospective cohort study to clarify whether folic acid supplementation benefits ESRD patient survival. Patients were divided into a folic acid supplementation group and a control group. All-cause and cardiovascular-related mortality rates between groups were compared.


RESULTS
In total, 55,636 stable incident hemodialysis patients were identified from the database. Using a propensity score-matched method and intention-to-treat analysis, the survival rate of 17,000 patients with folic acid supplementation was compared with a 1:1 matched control group. The baseline demographic data and comorbid disease incidence between the 2 groups were comparable. During the study period, the mortality rate in the matched pair cohort was 35.5% (n = 6,030) over a mean follow-up period of 3.0 years, corresponding to a mortality rate of 12.8/100 patient-years. The all-cause mortality rates were 12.3 and 13.4/100 patient-years in the folic acid group and control group, respectively (p = 0.005).


CONCLUSIONS
In adult hemodialysis patients, folic acid supplementation improves cardiovascular and all-cause mortality rates.
Department of Pharmacy, Taipei Medical University Hospital, Taipei - Taiwan; Clinical Research Center, Taipei Medical University Hospital and School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei - Taiwan.
Shu-Chen
SC
Chien
Szu-Yuan
SY
Li
Yung-Tai
YT
Chen
Lung-Wen
LW
Tsai
Tzeng-Ji
TJ
Chen
Tzen-Wen
TW
Chen
Yi-Chun
YC
Lin
D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D057194:Intention to Treat Analysis; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014803:Vitamin B Complex / Q000008:administration & dosage*
D014803:Vitamin B Complex; D005492:Folic Acid