Effects of High Dose Folate and Vitamin B12 on Hyperhomocysteinemia in Maintenance Hemodialysis Patients

Abstract

Background: A well-known risk factor for accelerated atherosclerosis in hemodialysis patients is hyperhomocysteinemia. In hemodialysis patients, folic acid and vitamin B12 have been administered singly or in combination to lower homocysteine (Hcy) levels. Objectives: To evaluate the effect of high dose folate and vitamin B12, alone or in combination, on hyperhomocysteinemia in maintenance hemodialysis patients. Methods: This is a prospective interventional study and conducted at the Department of Nephrology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study included 88 patients of maintenance hemodialysis with hyperhomocysteinemia. They were randomly distributed into four equal groups by lottery method, 22 patients who received only folic acid (FA), 15mg/day for a period of 8 weeks was considered as group I, 22 patients who received only Inj. vitamin B12, 1000 µg/4 weeks for a period of 8 weeks was considered as group II, 22 patients who received combination of folic acid (FA), 15mg/day and Inj. Vitamin B12, 1000µg/4 weeks for a period of 8 weeks was considered as group III and rest 22 patients who did not receive any intervention was considered as group IV (Control). Total plasma homocysteine, serum folate, and vitamin B12 levels were evaluated before and after intervention. The data were statistically analysed using window-based computer programme designed with Statistical Packages for Social Sciences (SPSS-22). Results: The mean plasma total homocysteine (tHcy) at baseline was 32.52±8.68 (µmol/L) in group I, 31.45±9.94 (µmol/L) in group II, 33.29±11.08 (µmol/L) in group III, 31.61±6.87 (µmol/L) in group IV. The mean plasma tHcy at the end of 2nd month (post intervention) reduced to 26.45±6.23 (µmol/L) in group I, 27.38±7.63 (µmol/L) in group II and 21.72±6.91 (µmol/L) in group III and 29.98±7.05 (µmol/L) in group IV. The reduced plasma tHcy at the end of 2nd month was statistically significant (p=0.001) among four groups. The mean reduction (%) of tHcy was 18.7 in group I, 12.95 in group II, 34.76 in group III and 5.16 in group IV. The mean serum folic acid at the end of 2nd month was 22.94±6.62 (ng/ml) in group I, 6.68±1.9 (ng/ml) in group II, 25.03±5.18 (ng/ml) in group III and 7.35±1.87 (ng/ml) in group IV. The mean serum vitamin B12 at the end of 2nd month was 388.14±191.55 (pg/ml) in group I, 1120.8±204.4 (pg/ml) in group II, 1066.8±228.58 (pg/ml) in group III and 385±99.05(pg/ml) in group IV. The difference of serum folic acid and serum vitamin B12 at the end of 2nd month were statistically significant (p<0.05) among four groups. Conclusion: High dose folate and vitamin B12, alone or in combination were effective in reducing homocysteine level in maintenance hemodialysis patients.