Is folate supplementation necessary in hemodialysis patients on erythropoietin therapy

The need for folate supplementation in hemodialysis (HD) patients receiving erythropoietin (EPO) therapy remains unknown. Twenty stable HD patients, taking folic acid, 5 mg, after a meal during each HD session were divided into two groups. Supplementation was withdrawn at the start of the study in group 1 and after a 12-month-observation period in group 2. EPO treatment, 1500 u x 3/week i.v. was started in both groups. Pre- and post-HD blood samples were obtained at the beginning of the study for baseline values, then 12 and 18 months later. Folate levels decreased to normal after withdrawal of the supplements. The response to EPO treatment was exactly the same in both groups and the anemia was effectively improved. We conclude that there is no need for routine folic acid supplements in HD patients receiving EPO therapy if they are eating an adequate mixed diet.