High doses of oral folate and sublingual vitamin B12 in dialysis patients with hyperhomocysteinemia.
BACKGROUND
Folic acid and vitamin B12, alone or in combination have been used to reduce homocysteine (Hcy) levels in dialysis patients.


OBJECTIVE
We aimed to assess the efficacy of high doses of oral folate and vitamin B12 in reducing plasma Hcy levels after a 12-week treatment.


METHODS
Thirty-two dialysis patients aged 10-324 months screened for hyperhomocysteinuria. Then cases with hyperhomocysteinemia received oral folate 10 mg/day with sublingual methylcobalamin 1 mg/day for 12 weeks. In pre- and post-intervention phases plasma Hcy concentration, serum folate, and vitamin B12 levels were measured. Changes in plasma Hcy, serum folate, and vitamin B12 concentrations were analyzed by paired t tests, and P values < 0.05 were considered significant.


RESULTS
Eighteen (56.2%) patients had hyperhomocysteinuria. Vitamin B12 and folate levels were normal or high in all cases. Two patients were lost due to transplant or irregular drugs consumption. Plasma Hcy levels were reduced in all, and reached normal values in 50%. A statistically significant differences between first Hcy levels with levels after intervention was found (95% CI, 5.1-8.9, P = 0.0001).


CONCLUSIONS
Oral folate 10 mg/day in combination with sublingual vitamin B12, 1 mg/day can be considered as a favorable treatment for hyperhomocysteinemia in dialysis patients.
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Mitra
M
Naseri
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Gholam-Reza
GR
Sarvari
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad
M
Esmaeeli
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Anoush
A
Azarfar
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Zahra
Z
Rasouli
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Giti
G
Moeenolroayaa
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Shohre
S
Jahanshahi
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Simin
S
Farhadi
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Zohreh
Z
Heydari
Hemodialysis Section, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Narges
N
Sagheb-Taghipoor
Dialysis; Folate; Hyperhomocysteinemia; Vitamin B12
J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):197
9048724
Pediatr Nephrol. 2001 Oct;16(10):805-11
11605787
JAMA. 2002 Oct 23-30;288(16):2015-22
12387654
Nephrol Dial Transplant. 2002 May;17(5):916-22
11981084
Arch Intern Med. 2003 Sep 8;163(16):1933-7
12963566
Annu Rev Med. 1998;49:31-62
9509248
Prev Cardiol. 2006 Summer;9(3):178-82
16849882
Clin Nephrol. 1999 Feb;51(2):108-15
10069646
Saudi J Kidney Dis Transpl. 2009 Sep;20(5):779-88
19736473
J Nephrol. 2003 Jul-Aug;16(4):522-34
14696754
Am J Nephrol. 2004 May-Jun;24(3):289-95
15087588
Scand J Clin Lab Invest. 1988 May;48(3):215-21
3375778
Am J Clin Nutr. 2005 Oct;82(4):806-12
16210710
Mt Sinai J Med. 2005 Nov;72(6):365-73
16358160
Pediatr Nephrol. 1999 Sep;13(7):583-5
10460506
Pediatr Nephrol. 2007 Oct;22(10):1689-702
17216263
Arch Intern Med. 1998 Apr 27;158(8):862-7
9570171
Metabolism. 2005 Jun;54(6):835-40
15931623
JAMA. 1995 Oct 4;274(13):1049-57
7563456
Metabolism. 1999 May;48(5):631-5
10337865
Metabolism. 2002 Jul;51(7):881-6
12077735
BMJ. 2002 Nov 23;325(7374):1202
12446535
Am J Clin Nutr. 1987 Apr;45(4):737-43
3565301
Med Sci Monit. 2003 Apr;9(4):PI19-24
12709680
Iran J Kidney Dis. 2011 Mar;5(2):93-6
21368386
Kidney Int. 1996 Jan;49(1):147-52
8770960
Clin Nephrol. 1993 Oct;40(4):236-40
8261682
BMJ. 2006 Nov 25;333(7578):1114-7
17124224
Kidney Int. 2001 Mar;59(3):1103-9
11231366
Kidney Int. 1997 Aug;52(2):495-502
9264008
Miner Electrolyte Metab. 1996;22(1-3):110-4
8676799
Nutr Clin Care. 2002 Jan-Feb;5(1):20-4
12134715
Nephrol Dial Transplant. 2002 Mar;17(3):455-61
11865092
Am J Clin Nutr. 1994 Jul;60(1):2-11
8017332
Clin Chem. 2006 Jan;52(1):145-8
16391331
J Am Soc Nephrol. 2000 Jun;11(6):1106-1116
10820175