Nephrology Dialysis Transplantation, Vol 13, Issue 1 106-112, Copyright © 1998 by Oxford University Press
C van Guldener, M Janssen, J Lambert, P ter Wee, C Jakobs, A Donker and C Stehouwer
Background: Hyperhomocysteinaemia is frequent in
chronic haemodialysis patients. Because of its potential role in athero-and
thrombogenesis, the effects of long-term homocysteine-lowering treatment on
endothelial function are of interest. Methods: We
conducted a randomized, controlled trial in 35 haemodialysis patients. In
phase 1, patients were treated with 5 mg folic acid or 5 mg folic acid and
4 g betaine per day for 12 weeks, and in phase 2 with 1 or 5 mg folic acid
daily for 40 weeks. In phase 3, all patients received 15 mg folic acid
daily for four weeks. Endothelial function was assessed before and after 52
weeks of treatment by determination of flow-mediated vasodilatation of the
brachial artery, and by measuring plasma levels of endothelium-derived
proteins. Results: Non-fasting predialysis plasma
total homocysteine was markedly elevated at baseline (46.9±6.3
&mgr;mol/l) and decreased rapidly after initiation of therapy.
Significant differences in plasma homocysteine between the groups were
found neither during phase 1 nor phase 2. Plasma total homocysteine had
normalized in only two out of 50 patients at the end of phase 2. Increasing
the daily folic acid dose to 15 mg did not further reduce plasma total
homocysteine. Endothelial function parameters did not improve.
Conclusions: We concluded that betaine is not
effective in conjunction with folic acid in the treatment of
hyperhomocysteinaemia in haemodialysis patients. Normalization of plasma
total homocysteine is seldom achieved with 1, 5 or 15 mg folic acid daily,
which may explain why long-term homocysteine-lowering treatment with 1 or 5
mg folic acid does not ameliorate endothelial function. Key
words: Hyperhomocysteinaemia; endothelial function;
haemodialysis; folic acid; betaine
ORIGINAL ARTICLES
No change in impaired endothelial function after long-term folic acid therapy of hyperhomocytsteinaemia in haemodialysis patients
Departments of Internal Medicine, Nephrology, and Clinical Chemistry and Paediatrics, University Hospital and Institute for Cardiovascular Research, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Corresponding author
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