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Effect of folic acid and betaine on fasting and postmethionine-loading plasma homocysteine and methionine levels in chronic haemodialysis patients.

Abstract

OBJECTIVES

To study fasting and postmethionine-loading (increment and decrement) plasma homocysteine levels in end-stage renal disease (ESRD) patients in relation to B-vitamin status and after folic acid treatment without or with betaine.

DESIGN

Plasma total homocysteine (tHcy) and methionine levels were measured in chronic haemodialysis patients after an overnight fast, and 6 and 24 h after an oral methionine load (0.1 g kg-1). The patients were subsequently randomized to treatment with folic acid 5 mg daily with or without betaine 4 g daily, and the loading test was repeated after 12 weeks. The patients were then re-randomized to treatment with 1 or 5 mg folic acid daily for 40 weeks, after which a third loading test was performed.

SETTING

Haemodialysis unit of university hospital and centre for haemodialysis.

SUBJECTS

Twenty-nine consecutive maintenance (> 3 months) haemodialysis patients, not on folic acid supplementation, 26 of whom completed the study.

RESULTS

At baseline, the mean fasting, the 6 h postload and the 6 h postload increment plasma tHcy levels were increased as compared with those in healthy controls (46.8 +/- 6.9 (SEM), 92.8 +/- 9.1 and 46.0 +/- 4.2 mumol L-1, respectively) and correlated with serum folate (r = -0.42, P = 0.02; r = -0.61, P = 0.001 and r = -0.54, P = 0.003, respectively), but not with vitamin B6 or vitamin B12. At week 12, these variables had all decreased significantly. Betaine did not have additional homocysteine-lowering effects. At week 52, fasting and postload tHcy levels did not differ significantly between patients on 1 or 5 mg folic acid daily. Plasma tHcy half-life and plasma methionine levels after methionine loading were not altered by folic acid treatment.

CONCLUSIONS

In chronic haemodialysis patients, fasting as well as postmethionine-loading plasma tHcy levels depend on folate status and decrease after folic acid therapy. Increased postload homocysteine levels in these patients therefore do not necessarily indicate an impaired transsulphuration capacity only; alternatively, folate may indirectly influence transsulphuration. The elucidation of the complex pathogenesis of hyperhomocysteinaemia in chronic renal failure requires further investigation.

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  • Authors+Show Affiliations

    ,

    Department of Nephrology, Vrije Universiteit, Amsterdam, The Netherlands.

    , , ,

    Source

    Journal of internal medicine 245:2 1999 Feb pg 175-83

    MeSH

    Adult
    Betaine
    Fasting
    Female
    Folic Acid
    Hematinics
    Homocysteine
    Humans
    Hyperhomocysteinemia
    Kidney Failure, Chronic
    Male
    Methionine
    Methylation
    Middle Aged
    Renal Dialysis
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    10081520

    Citation

    van Guldener, C, et al. "Effect of Folic Acid and Betaine On Fasting and Postmethionine-loading Plasma Homocysteine and Methionine Levels in Chronic Haemodialysis Patients." Journal of Internal Medicine, vol. 245, no. 2, 1999, pp. 175-83.
    van Guldener C, Janssen MJ, de Meer K, et al. Effect of folic acid and betaine on fasting and postmethionine-loading plasma homocysteine and methionine levels in chronic haemodialysis patients. J Intern Med. 1999;245(2):175-83.
    van Guldener, C., Janssen, M. J., de Meer, K., Donker, A. J., & Stehouwer, C. D. (1999). Effect of folic acid and betaine on fasting and postmethionine-loading plasma homocysteine and methionine levels in chronic haemodialysis patients. Journal of Internal Medicine, 245(2), pp. 175-83.
    van Guldener C, et al. Effect of Folic Acid and Betaine On Fasting and Postmethionine-loading Plasma Homocysteine and Methionine Levels in Chronic Haemodialysis Patients. J Intern Med. 1999;245(2):175-83. PubMed PMID: 10081520.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of folic acid and betaine on fasting and postmethionine-loading plasma homocysteine and methionine levels in chronic haemodialysis patients. AU - van Guldener,C, AU - Janssen,M J, AU - de Meer,K, AU - Donker,A J, AU - Stehouwer,C D, PY - 1999/3/19/pubmed PY - 1999/3/19/medline PY - 1999/3/19/entrez SP - 175 EP - 83 JF - Journal of internal medicine JO - J. Intern. Med. VL - 245 IS - 2 N2 - OBJECTIVES: To study fasting and postmethionine-loading (increment and decrement) plasma homocysteine levels in end-stage renal disease (ESRD) patients in relation to B-vitamin status and after folic acid treatment without or with betaine. DESIGN: Plasma total homocysteine (tHcy) and methionine levels were measured in chronic haemodialysis patients after an overnight fast, and 6 and 24 h after an oral methionine load (0.1 g kg-1). The patients were subsequently randomized to treatment with folic acid 5 mg daily with or without betaine 4 g daily, and the loading test was repeated after 12 weeks. The patients were then re-randomized to treatment with 1 or 5 mg folic acid daily for 40 weeks, after which a third loading test was performed. SETTING: Haemodialysis unit of university hospital and centre for haemodialysis. SUBJECTS: Twenty-nine consecutive maintenance (> 3 months) haemodialysis patients, not on folic acid supplementation, 26 of whom completed the study. RESULTS: At baseline, the mean fasting, the 6 h postload and the 6 h postload increment plasma tHcy levels were increased as compared with those in healthy controls (46.8 +/- 6.9 (SEM), 92.8 +/- 9.1 and 46.0 +/- 4.2 mumol L-1, respectively) and correlated with serum folate (r = -0.42, P = 0.02; r = -0.61, P = 0.001 and r = -0.54, P = 0.003, respectively), but not with vitamin B6 or vitamin B12. At week 12, these variables had all decreased significantly. Betaine did not have additional homocysteine-lowering effects. At week 52, fasting and postload tHcy levels did not differ significantly between patients on 1 or 5 mg folic acid daily. Plasma tHcy half-life and plasma methionine levels after methionine loading were not altered by folic acid treatment. CONCLUSIONS: In chronic haemodialysis patients, fasting as well as postmethionine-loading plasma tHcy levels depend on folate status and decrease after folic acid therapy. Increased postload homocysteine levels in these patients therefore do not necessarily indicate an impaired transsulphuration capacity only; alternatively, folate may indirectly influence transsulphuration. The elucidation of the complex pathogenesis of hyperhomocysteinaemia in chronic renal failure requires further investigation. SN - 0954-6820 UR - https://www.unboundmedicine.com/medline/citation/10081520/Effect_of_folic_acid_and_betaine_on_fasting_and_postmethionine_loading_plasma_homocysteine_and_methionine_levels_in_chronic_haemodialysis_patients_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0954-6820&date=1999&volume=245&issue=2&spage=175 DB - PRIME DP - Unbound Medicine ER -