The achievement of normal homocysteinemia in regular extracorporeal dialysis patients

High total homocysteinemia (tHcy) is a vascular risk factor in regular dialysis treatment (RDT) patients. A near normal tHcy has previously been achieved (from 33 +/- 11 to 13 +/- 5 micromol/L) in 23 patients on hemodiafiltration (HDF) by adjusting intravenous (i.v.) supplements of folinic acid, vitamin B12 and B6, gradually during a 2-yr follow-up. Thereafter, the same therapeutic schedule was used for all patients undergoing RDT in our unit to confirm its efficacy on a larger scale.

Patients (n=63, F 34, age 66 +/- 14 yrs, dialytic age 60 +/- 53 months) underwent high UF post-dilutional on-line HDF for at least 6 months. They received i.v. folinic acid 3 mg, vitamin B12 50 microg and vitamin B6 450 mg/wkly. After 4 months, pre- and post-dialytic serum Hcy (n.v. 11 +/- 2 micromol/L), as well as pre-dialytic serum folate (sFA, n.v. 3-17 ng/mL) and vitamin B12 (sB12, n.v. 226-966 pg/mL) were determined.

The mean pre-dialytic tHcy fell to within the normal range (from 31 +/- 10 to 12.5 +/- 5 umol/L), it was slightly above the normal limits (19 +/- 2 umol/L) in only 11 patients (17%), whereas the post-dialytic value was normal in all patients (7 +/- 2.5 umol/L). The average values of sFA (25 +/- 10 ng/mL) and sB12 (1500 +/- 320 pg/mL) were approximately twice the normal limits.

Therefore, HDF appears to remove tHcy efficiently and tHcy is generally normalized by adjusting the dose of vitamin B12, vitamin B6 and folinic acid supplements.