Dierkes J, Domröse U, Ambrosch A, Bosselmann H P, Neumann K H, Luley C
Institute of Clinical Chemistry, University Hospital, Magdeburg, Germany.
Clin Nephrol. 1999 Feb;51(2):108-15.
Elevated concentrations of homocysteine are associated with an increased risk for cardiovascular disease. Reasons for elevated homocysteine concentrations are folate or vitamin B12 deficiency, renal disease or genetic abnormalities. A high prevalence of hyperhomocysteinemia is found in patients with end-stage renal disease (ESRD). Since these patients are also at increased risk for vitamin deficiency, a supplementation study comparing two doses of folic acid was performed in patients with ESRD treated with maintenance hemodialysis or with peritoneal dialysis.
Patients undergoing hemodialysis (n = 70) or peritoneal dialysis (n = 12) were supplemented with 2.5 mg or 5 mg folic acid (three times per week after each dialysis treatment) for four weeks in a parallel study design. In 20 hemodialysis patients, the effect of folic acid withdrawal was observed after four weeks.
Both supplementation schemes reduced homocysteine to a similar extent (35%) but did not normalize homocysteine concentrations in the majority of patients. Dialysis also had a strong homocysteine lowering effect. After supplementation, 74% of the hemodialysis patients had post-dialysis homocysteine concentrations within the reference range (<16 micromol/l). Homocysteine concentrations remained decreased in 20 patients four weeks after withdrawal of folic acid supplementation.
It is concluded that supplementation with 2.5 or 5 mg folic acid has a similar effect on homocysteine concentrations to supplementation regimens using 15 mg folic acid supplements. In contrast to the effect of folic acid supplementation in subjects with normal renal function, folic acid supplementation does not normalize homocysteine concentrations in ESRD patients.
同型半胱氨酸浓度升高与心血管疾病风险增加相关。同型半胱氨酸浓度升高的原因包括叶酸或维生素B12缺乏、肾脏疾病或基因异常。终末期肾病（ESRD）患者中高同型半胱氨酸血症的患病率很高。由于这些患者维生素缺乏风险也增加，因此对接受维持性血液透析或腹膜透析的ESRD患者进行了一项比较两种叶酸剂量的补充研究。
在一项平行研究设计中，对接受血液透析的患者（n = 70）或腹膜透析的患者（n = 12）补充2.5毫克或5毫克叶酸（每次透析治疗后每周三次），持续四周。在20名血液透析患者中，观察了四周后停用叶酸的效果。
两种补充方案均使同型半胱氨酸降低程度相似（35%），但大多数患者的同型半胱氨酸浓度未恢复正常。透析也有很强的降低同型半胱氨酸的作用。补充后，74%的血液透析患者透析后的同型半胱氨酸浓度在参考范围内（<16微摩尔/升）。在停用叶酸补充剂四周后，20名患者的同型半胱氨酸浓度仍保持降低。
得出结论，补充2.5毫克或5毫克叶酸对同型半胱氨酸浓度的影响与使用15毫克叶酸补充剂的补充方案相似。与叶酸补充对肾功能正常受试者的影响相反，叶酸补充不能使ESRD患者的同型半胱氨酸浓度恢复正常。
