Effect of Incremental Doses of Folate on Homocysteine and Metabolically Related Vitamin Concentrations in Nondiabetic Patients on Peritoneal Dialysis

Amedeo F. De Vecchi, C. Novembrino, M. C. Patrosso, D. Cresseri, S. Ippolito, M. Rosina, P. Colucci, G. Lando, F. Bamonti Catena

Research output: Contribution to journalArticle

Abstract

The role of folate supplementation in reducing hyperhomocystinemia in patients on dialysis has been reported, but the optimal dose of folate is still unknown. The aim of the present study was to investigate whether greater than 5 mg/day folate supplementation provides any additional effect on plasma homocysteine (HCY) levels. The study was prospective, open, and had no control group. Of the 64 eligible nondiabetic patients on peritoneal dialysis with hyperhomocystinemia (>20 μmol/L), 56 were given oral folate (5 mg/day) for 3 months. When Hcy did not fall below 20 μmol/L, folate doses were increased by 5 mg every 3 months to up to 15 mg/day. With 5 mg/day supplementation, serum folate concentrations increased above the upper confidence limit in 23 patients and erythrocyte folate concentrations in 27 patients. Hcy levels decreased to less than 15 μmol/L in 6 cases and by more than 50% in 12 cases. Nineteen of the remaining patients were given 10 mg/day folate. After increasing the dose, serum and erythrocyte folate levels rose above the upper detection limit. In one patient, plasma Hcy concentrations decreased to less than 15 μmol/L. Ten patients were given 15 mg/day oral folate for an additional 3 months with no effect on homocystinemia. This study confirms that oral folate supplementation may improve hyperhomocystinemia even in patients on dialysis with normal serum or erythrocyte folate concentrations. In fact, serum and erythrocyte levels cannot predict the effect of supplementation on plasma Hcy levels. However, 5 mg/day folate supplementation normalized Hcy in 10% of cases and reduced Hcy levels in another 21%. Increasing the folate dose to greater than 5 mg/day had a minimal (10 mg/day) or no (15 mg/day) additional effect on Hcy concentrations. Despite the minimal effect of increasing folate doses, given the low cost, the absence of side effects, and the high cardiovascular risk for patients on peritoneal dialysis, a careful attempt to increase the dose of oral folate up to 10 mg/day might be suggested.

Original languageEnglish
Pages (from-to)655-659
Number of pages5
JournalASAIO Journal
Volume49
Issue number6
DOIs
Publication statusPublished - Nov 2003

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Dialysis
Vitamins
Peritoneal Dialysis
Homocysteine
Folic Acid
Plasmas
Erythrocytes
Serum
Costs

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering

Cite this

Effect of Incremental Doses of Folate on Homocysteine and Metabolically Related Vitamin Concentrations in Nondiabetic Patients on Peritoneal Dialysis. / De Vecchi, Amedeo F.; Novembrino, C.; Patrosso, M. C.; Cresseri, D.; Ippolito, S.; Rosina, M.; Colucci, P.; Lando, G.; Bamonti Catena, F.

In: ASAIO Journal, Vol. 49, No. 6, 11.2003, p. 655-659.

Research output: Contribution to journalArticle

De Vecchi, Amedeo F. ; Novembrino, C. ; Patrosso, M. C. ; Cresseri, D. ; Ippolito, S. ; Rosina, M. ; Colucci, P. ; Lando, G. ; Bamonti Catena, F. / Effect of Incremental Doses of Folate on Homocysteine and Metabolically Related Vitamin Concentrations in Nondiabetic Patients on Peritoneal Dialysis. In: ASAIO Journal. 2003 ; Vol. 49, No. 6. pp. 655-659.
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abstract = "The role of folate supplementation in reducing hyperhomocystinemia in patients on dialysis has been reported, but the optimal dose of folate is still unknown. The aim of the present study was to investigate whether greater than 5 mg/day folate supplementation provides any additional effect on plasma homocysteine (HCY) levels. The study was prospective, open, and had no control group. Of the 64 eligible nondiabetic patients on peritoneal dialysis with hyperhomocystinemia (>20 μmol/L), 56 were given oral folate (5 mg/day) for 3 months. When Hcy did not fall below 20 μmol/L, folate doses were increased by 5 mg every 3 months to up to 15 mg/day. With 5 mg/day supplementation, serum folate concentrations increased above the upper confidence limit in 23 patients and erythrocyte folate concentrations in 27 patients. Hcy levels decreased to less than 15 μmol/L in 6 cases and by more than 50{\%} in 12 cases. Nineteen of the remaining patients were given 10 mg/day folate. After increasing the dose, serum and erythrocyte folate levels rose above the upper detection limit. In one patient, plasma Hcy concentrations decreased to less than 15 μmol/L. Ten patients were given 15 mg/day oral folate for an additional 3 months with no effect on homocystinemia. This study confirms that oral folate supplementation may improve hyperhomocystinemia even in patients on dialysis with normal serum or erythrocyte folate concentrations. In fact, serum and erythrocyte levels cannot predict the effect of supplementation on plasma Hcy levels. However, 5 mg/day folate supplementation normalized Hcy in 10{\%} of cases and reduced Hcy levels in another 21{\%}. Increasing the folate dose to greater than 5 mg/day had a minimal (10 mg/day) or no (15 mg/day) additional effect on Hcy concentrations. Despite the minimal effect of increasing folate doses, given the low cost, the absence of side effects, and the high cardiovascular risk for patients on peritoneal dialysis, a careful attempt to increase the dose of oral folate up to 10 mg/day might be suggested.",
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AU - Patrosso, M. C.

AU - Cresseri, D.

AU - Ippolito, S.

AU - Rosina, M.

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