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[The treatment of hyperhomocysteinemia in patients on dialysis: folic acid or the high-flow polysulphonic membrane?].
Acta Med Croatica 2006; 60(3):201-8AM

Abstract

AIM

The aim of the study was to determine the effects of high-flow and low-flow hemodialysis (HD), with simultaneous treatment with folic acid and vitamin B12, on total homocysteine (tHcy) concentration in plasma of dialyzed patients.

METHODS

The planned clinical observation included 46 patients of both sexes, aged 21-82, treated with bicarbonate dialysis for a mean of 4.7 years. The patients were divided into group A, subsequently dialyzed by use of high-flow polysulphonic membrane (AN 69ST, Nephral 300), and group B that continued to be dialyzed by use of low-flow diacetate membrane (Diacepal 14 and 16). The subjects in both groups received 30 mg of folic acid at the end of each dialysis (3 times a week), and 500 g of vitamin B12 at the end of every other dialysis. The method of stable isotopic dilution mass spectrometry was used to measure tHcy. Folic acid was determined by the test based on ion capture technology. Vitamin B12 was determined by MEIA.

RESULTS

An increase in the concentration of tHcy was observed in 39/46 (85%) patients with a mean concentration of 24.76 +/- 11.04 micromol/L. The mean concentration of folic acid and vitamin B12 was within the normal limits. In the group dialyzed by high-flow dialyzer, the values of tHcy and folic acid decreased (18.74 +/- 2.95 micromol/L and 13.90 +/- 6.78 pmol/L) after hemodialysis, which was significant compared to the initial value (p<0.01 and p<0.05, respectively). At four weeks of treatment, tHcy concentration before HD showed a significant decrease both in the group dialyzed by high-flow dialyzer (15.10 +/- 4.26 mmol/L, p<0.01) and in the group dialyzed by low-flow dialyzer (12.54 +/- 3.87 micromol/L, p<0.01) compared to the measure before HD and before the treatment. There was no statistically significant difference (z -0.40, p>0.68) in the percentage of tHcy change between the group treated by high-flow dialyzer and the group treated by low-flow dialyzer in the measurements before HD and before the treatment with folic acid and vitamin B12, and after the treatment.

DISCUSSION

There is a literature report on the concentration increase by 26 micromol/L, which is very similar to our result. The absence of long-term effect on predialysis concentration of tHcy in HD by high-flow membrane has also been described, because the decrease of tHcy is mantained until the uremic toxins, enzyme inhibitors that are necessary for the process of remethylation of Hcy, accumulated again. During high-flow HD, the folic acid concentration decreased by 23.05% on an average, consistent with other literature reports. Some reports support our observation that the dosage of folic acid required for tHcy decrease is 15-30 mg, and that the dosage higher than 60 mg does not significantly decrease tHcy concentration. Our study confirmed the reported observations that treatment with folic acid and vitamin B12 rather than high-flow dialyzer contributes to tHcy decrease.

CONCLUSION

The study confirmed the high prevalence of hyperhomocysteinemia in patients on dialysis. The treatment with folic acid and vitamin B12 results in a significant decrease of tHcy. After individual HD by high-flow dialyzer, there is a significant, but temporary decrease of tHcy concentration in plasma. There is no significant difference in the efficiency on pre-dialysis tHcy concentration between the high-flow and low-flow dialyzer membrane. Because of the atherogenic effect of hyperhomocysteinemia, the treatment with folic acid and vitamin B12 should be accepted as an options to lower the risk factors for the rapid atherosclerosis in patients on dialysis, thus reducing the occurrence and fatality of cardiovascular diseases.

Authors+Show Affiliations

Centar za dijalizu, Odjel za internu medicinu, Opća bolnica Bjelovar, Hrvatska.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

hrv

PubMed ID

16933832

Citation

Lovcić, Vesna, et al. "[The Treatment of Hyperhomocysteinemia in Patients On Dialysis: Folic Acid or the High-flow Polysulphonic Membrane?]." Acta Medica Croatica : Casopis Hravatske Akademije Medicinskih Znanosti, vol. 60, no. 3, 2006, pp. 201-8.
Lovcić V, Kes P, Zeljko R, et al. [The treatment of hyperhomocysteinemia in patients on dialysis: folic acid or the high-flow polysulphonic membrane?]. Acta Med Croatica. 2006;60(3):201-8.
Lovcić, V., Kes, P., Zeljko, R., & Kusec, V. (2006). [The treatment of hyperhomocysteinemia in patients on dialysis: folic acid or the high-flow polysulphonic membrane?]. Acta Medica Croatica : Casopis Hravatske Akademije Medicinskih Znanosti, 60(3), pp. 201-8.
Lovcić V, et al. [The Treatment of Hyperhomocysteinemia in Patients On Dialysis: Folic Acid or the High-flow Polysulphonic Membrane?]. Acta Med Croatica. 2006;60(3):201-8. PubMed PMID: 16933832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The treatment of hyperhomocysteinemia in patients on dialysis: folic acid or the high-flow polysulphonic membrane?]. AU - Lovcić,Vesna, AU - Kes,Petar, AU - Zeljko,Reiner, AU - Kusec,Vesna, PY - 2006/8/29/pubmed PY - 2006/10/27/medline PY - 2006/8/29/entrez SP - 201 EP - 8 JF - Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti JO - Acta Med Croatica VL - 60 IS - 3 N2 - AIM: The aim of the study was to determine the effects of high-flow and low-flow hemodialysis (HD), with simultaneous treatment with folic acid and vitamin B12, on total homocysteine (tHcy) concentration in plasma of dialyzed patients. METHODS: The planned clinical observation included 46 patients of both sexes, aged 21-82, treated with bicarbonate dialysis for a mean of 4.7 years. The patients were divided into group A, subsequently dialyzed by use of high-flow polysulphonic membrane (AN 69ST, Nephral 300), and group B that continued to be dialyzed by use of low-flow diacetate membrane (Diacepal 14 and 16). The subjects in both groups received 30 mg of folic acid at the end of each dialysis (3 times a week), and 500 g of vitamin B12 at the end of every other dialysis. The method of stable isotopic dilution mass spectrometry was used to measure tHcy. Folic acid was determined by the test based on ion capture technology. Vitamin B12 was determined by MEIA. RESULTS: An increase in the concentration of tHcy was observed in 39/46 (85%) patients with a mean concentration of 24.76 +/- 11.04 micromol/L. The mean concentration of folic acid and vitamin B12 was within the normal limits. In the group dialyzed by high-flow dialyzer, the values of tHcy and folic acid decreased (18.74 +/- 2.95 micromol/L and 13.90 +/- 6.78 pmol/L) after hemodialysis, which was significant compared to the initial value (p<0.01 and p<0.05, respectively). At four weeks of treatment, tHcy concentration before HD showed a significant decrease both in the group dialyzed by high-flow dialyzer (15.10 +/- 4.26 mmol/L, p<0.01) and in the group dialyzed by low-flow dialyzer (12.54 +/- 3.87 micromol/L, p<0.01) compared to the measure before HD and before the treatment. There was no statistically significant difference (z -0.40, p>0.68) in the percentage of tHcy change between the group treated by high-flow dialyzer and the group treated by low-flow dialyzer in the measurements before HD and before the treatment with folic acid and vitamin B12, and after the treatment. DISCUSSION: There is a literature report on the concentration increase by 26 micromol/L, which is very similar to our result. The absence of long-term effect on predialysis concentration of tHcy in HD by high-flow membrane has also been described, because the decrease of tHcy is mantained until the uremic toxins, enzyme inhibitors that are necessary for the process of remethylation of Hcy, accumulated again. During high-flow HD, the folic acid concentration decreased by 23.05% on an average, consistent with other literature reports. Some reports support our observation that the dosage of folic acid required for tHcy decrease is 15-30 mg, and that the dosage higher than 60 mg does not significantly decrease tHcy concentration. Our study confirmed the reported observations that treatment with folic acid and vitamin B12 rather than high-flow dialyzer contributes to tHcy decrease. CONCLUSION: The study confirmed the high prevalence of hyperhomocysteinemia in patients on dialysis. The treatment with folic acid and vitamin B12 results in a significant decrease of tHcy. After individual HD by high-flow dialyzer, there is a significant, but temporary decrease of tHcy concentration in plasma. There is no significant difference in the efficiency on pre-dialysis tHcy concentration between the high-flow and low-flow dialyzer membrane. Because of the atherogenic effect of hyperhomocysteinemia, the treatment with folic acid and vitamin B12 should be accepted as an options to lower the risk factors for the rapid atherosclerosis in patients on dialysis, thus reducing the occurrence and fatality of cardiovascular diseases. SN - 1330-0164 UR - https://www.unboundmedicine.com/medline/citation/16933832/[The_treatment_of_hyperhomocysteinemia_in_patients_on_dialysis:_folic_acid_or_the_high_flow_polysulphonic_membrane]_ L2 - https://medlineplus.gov/bvitamins.html DB - PRIME DP - Unbound Medicine ER -