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Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary

Long Peng1, Xing Shui1, Fang Tan2,3

  • 1Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Frontiers in Cardiovascular Medicine
|October 18, 2021
PubMed

Insights

Folic acid supplementation significantly reduced the incidence of contrast-induced nephropathy (CIN) in patients with hyperhomocysteinemia undergoing coronary catheterization. This intervention offers a protective strategy against kidney damage following contrast procedures.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Hyperhomocysteinemia is a recognized risk factor for contrast-induced nephropathy (CIN).
  • Previous studies in rats suggested folic acid could mitigate nephropathies, but human data were lacking.
  • This study investigated the efficacy of folic acid in preventing CIN in human patients with elevated homocysteine levels undergoing coronary procedures.

Observation:

  • A prospective, double-blind, randomized controlled trial was conducted with 412 patients with plasma homocysteine ≥15 μM.
  • Patients received either 5 mg of folic acid or a placebo perioperatively.
  • CIN was defined by a significant increase in serum creatinine within 48-72 hours post-procedure.

Findings:

  • The incidence of CIN was significantly lower in the folic acid treatment group (8% at 48h, 9% at 72h) compared to the placebo group (16% at 48h, 17% at 72h).
  • Logistic regression confirmed folic acid administration as a protective factor against CIN (P=0.019).
  • No serious adverse events were associated with folic acid, and no deaths or need for hemodialysis occurred in either group.

Implications:

  • Perioperative folic acid administration appears to be a safe and effective strategy to attenuate CIN in patients with hyperhomocysteinemia.
  • This finding suggests a potential clinical application of folic acid for kidney protection in individuals undergoing contrast-enhanced cardiovascular procedures.
  • Further research may explore optimal dosing and long-term outcomes of folic acid in this patient population.

Keywords:
acute kidney injurycontrast-induced nephropathycoronary catheterizationfolic acidhyperhomocysteinemia

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