Hemodial Int. 2007;11:210-216


Early folate supplementation by lowering plasma total homocysteine (tHcy) may prevent cardiovascular deterioration in patients with chronic renal failure, according to researchers in Brazil.

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Areuza C. A. Vianna, MD, of the State University of Londrina in Paraná, and his colleagues

conducted a two-year randomized placebo-controlled trial of 186 hemodialysis patients. Patients received either oral folic acid 10 mg three times weekly or an identical placebo immediately after every dialysis session. On admission, tHcy levels were above 13.9 µmol/L in 96.7% of patients (median 25 µmol/L).


In the placebo group, tHcy levels remained elevated at 6, 12, and 24 months, whereas oral folate significantly decreased tHcy to a median value of 10.5 µmol/L. The decrease was not significantly associated with a decline in cardiovascular events (MI, arrhythmias, angina, heart failure, and cerebrovascular accident).


During the study, 38 patients died from CVD, 17 in the folic acid group and 21 in the placebo arm. The oral folate group, however, had a significant decrease in carotid artery intimamedia wall thickness from 1.94 to 1.67 mm.