Effective Homocysteine-Lowering Vitamin B Treatment in Peritoneal Dialysis Patients

Abstract

Background

Hyperhomocysteinemia, a risk factor for atherosclerosis, is frequently detected in patients with renal failure. Vitamin B supplementation reduces but rarely normalizes homocysteine (Hcy) levels in hemodialysis patients. There are no data about the effects of vitamin B therapy on Hcy levels in patients on peritoneal dialysis (PD).

Aims

We performed this trial both to observe baseline plasma Hcy levels in PD patients and to assess the effects of vitamin B therapy on Hcy levels in continuous ambulatory PD patients.

Methods

We conducted a 6-month prospective study of the effects of vitamin B therapy on plasma Hcy levels. Biochemical analyses were obtained at baseline and after every phase of treatment with folic acid, folic acid plus vitamin B₁₂, and folic acid plus vitamin B₁₂ plus vitamin B₆. Eighteen of the 25 enrolled patients finished the study.

Results

Hyperhomocysteinemia was present in 83% of PD patients. We detected a trend toward a significant inverse relationship between baseline Hcy and folate levels. There were no significant correlations between baseline Hcy and vitamin B₁₂, peritoneal membrane permeability, dialytic efficiency, or computed peritoneal Hcy clearance. We obtained an effective decrease in mean Hcy concentration from 20 to 14.8 μmol/L after folic acid and vitamin B₁₂ treatment. We observed a further reduction in mean Hcy level to 12.8 μmol/L using the triple therapy; 72% of patients normalized their Hcy value.

Conclusions

High doses of folic acid, vitamin B₆, and vitamin B₁₂ normalize Hcy values in the majority of PD patients. This treatment may be important in reducing cardiovascular morbidity and mortality.