Therapy of hyperhomocysteinemia in end-stage renal disease patients

Because of a potential association with cardiovascular disease, birth defects, and various other conditions, an elevation of tHcy plasma levels has gained broad interest. The majority of chronic renal failure patients present with hyperhomocysteinemia, the causes of which are not completely understood. An increasing number of studies addressed the treatment of hyperhomocysteinemia in chronic renal failure patients. Folic acid combined with vitamin B6 and vitamin B12 is more effective in lowering tHcy levels than either cofactor alone. The optimal dose of folic acid appears to be 1 mg orally per day. Intravenous application of vitamin B12, giving 1 to 1.5 mg per week may be more effective than therapy with 1 mg orally per day. The role of vitamin B6 is far from clear. It may play a role in combination with folic acid and/or vitamin B12. Finally, general screening for and treatment of hyperhomocysteinemia is not recommended.