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Renal failure causes hyperhomocysteinemia, an important risk factor for cardiovascular disease and venous access thrombosis in end-stage renal disease (ESRD). Folic acid is necessary for homocysteine (Hcy) metabolism, and therapy with 1 mg/d or more of folic acid reduces plasma total Hcy (tHcy) concentrations in ESRD, although seldom to normal. In contrast to folic acid, the Hcy-lowering effect of vitamin B12 has not been well studied in ESRD. We performed a prospective randomized controlled clinical trial involving 24 maintenance hemodialysis patients with normal or supranormal serum folate and vitamin B12 concentrations who received either standard therapy, which included 5 to 6 mg folic acid, 5 to 10 mg pyridoxine, and 6 to 10 [mu ]g oral vitamin B12 per day, or standard therapy plus 1 mg hydroxocobalamin administered subcutaneously once per week after dialysis. Plasma tHcy and serum methylmalonic acid (MMA) concentrations were measured before and after 8 and 16 weeks of continuous treatment. Hydroxocobalamin reduced plasma tHcy by an average of 32% (P [lt ] .005) and serum MMA by an average of 19% (P [lt ] .001). The Hcy-lowering effect of hydroxocobalamin was independent of baseline serum vitamin B12, folic acid, and MMA concentrations. Patients with higher baseline plasma tHcy concentrations had the greatest response (r = 0.80; P [lt ] .002). These results show that parenteral hydroxocobalamin reduces plasma tHcy dramatically in vitamin B12-replete hemodialysis patients. Persons with considerable persisting hyperhomocysteinemia despite high-dose folic acid therapy are likely to respond to the addition of hydroxocobalamin, irrespective of their serum vitamin B12 concentrations.
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☆Supported by Grants No. MOP 36486 and MME 6712 from the Canadian Institutes of Health Research. K.M.E. was supported by scholarships from the Natural Sciences and Engineering Research Council of Canada and le Fonds pour la Formation de Chercheurs et l'Aide [agrave] la Recherche du Qu[eacute]bec.
© 2002 Published by Elsevier Inc. All rights reserved.