Folic Acid and Vitamin B12 Administration in CKD, Why Not?

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Nutritional Science

Background:

• Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit elevated cardiovascular risk, with events being the primary cause of mortality.
• Traditional risk factors do not fully account for this increased risk, prompting investigation into non-traditional factors like hyperhomocysteinemia and impaired B vitamin metabolism.

Purpose of the Study:

• To review the role of homocysteine, folic acid, and vitamin B12 metabolism impairment in CKD and ESRD.
• To summarize evidence regarding hyperhomocysteinemia, folic acid, and vitamin B12 as cardiovascular risk markers, therapeutic targets, and factors in CKD progression.

Main Methods:

• Literature review of studies investigating homocysteine, folic acid, and vitamin B12 in CKD and ESRD patients.
• Analysis of evidence linking these factors to cardiovascular risk, mortality, and kidney disease progression.

Main Results:

• Elevated homocysteine levels are common in CKD and ESRD patients.
• The precise role of hyperhomocysteinemia as a cardiovascular risk marker and therapeutic target in this population remains under investigation.
• Folic acid and vitamin B12 may have direct roles in tissue damage and cardiovascular risk beyond their function as homocysteine metabolism cofactors.

Conclusions:

• Impaired homocysteine, folic acid, and vitamin B12 metabolism are significant considerations in CKD and ESRD.
• Further research is needed to clarify the clinical utility of targeting these metabolic pathways for cardiovascular risk reduction and slowing CKD progression.