Effect of Short-Term Folate and Vitamin B Supplementation on Blood Homocysteine Level and Carotid Artery Wall Thickness in Chronic Hemodialysis Patients
Pakorn Tungkasereerak MD*, Leena Ong-ajyooth MD, Dr Med*, Walailak Chaiyasoot MD**, Sompong Ong-ajyooth B Pharm, MSc***, Wattana Leowattana MD****, Somkiat Vasuvattakul MD*, Kriengsak Vareesangthip MD, PhD*, Chairat Shayakul MD*, Thawee Chanchairujira MD*, Suchai Sritippayawan MD*
Affiliation : * Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ** Department of Radiology, Faculty of Medicine Siriraj, Hospital, Mahidol University *** Department of Biochemistry, Faculty of Medicine Siriraj, Hospital, Mahidol University **** Department of Clinical Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University
Objective : Hyperhomocysteinemia is an independent risk factor for atherosclerotic vascular disease in
chronic hemodialysis patients. This stratified randomized controlled trial was designed to measure the effect
of high dose oral vitamin B6, vitamin B12, and folic acid on homocysteine levels, and to evaluate the effect on
atherosclerosis as measured by Intima-Media Thickness (IMT) of carotid arteries.
Materials and Methods : Fifty-four chronic hemodialysis patients with hyperhomocysteinemia were randomized
to receive oral 15 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 daily (treatment group) or oral 5
mg folic acid alone (control group) for 6 months. Homocysteine level and IMT were measured in both groups.
Results : At 6 months, homocysteine levels in the treatment group were significantly reduced from 27.94 (cid:31)
8.54 to 22.71 (cid:31) 3.68 mmol/l (p = 0.009) and were not significantly increased from 26.81 (cid:31) 7.10 to 30.82 (cid:31)
8.76 mmol/l in control group (p = 0.08). Mean difference between both groups was statistically significant
(p = 0.002). There was no significant difference of IMT of carotid arteries, however, a tendency that the
treatment group would have less thickness was observed (0.69 (cid:31) 0.29 mm and 0.62 (cid:31) 0.16 mm, p = 0.99).
Conclusion : Treatment of hyperhomocysteinemia in chronic hemodialysis patients with daily oral 15 mg
folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 for 6 months decreases homocysteine levels and tends to
reduce IMT of carotid arteries. A long term study for the prevention of atherosclerosis is warranted.
Keywords : Atherosclerosis, Carotid artery wall thickness, Folate, Hemodialysis, Homocysteinemia, Vitamin B6, Vitamin B12
