Pharmacological Dose of Vitamin B12 Is as Effective as Low-Dose Folinic Acid in Correcting Hyperhomocysteinemia of Hemodialysis Patients

Various regimens of folic acid-based and vitamin B12 (Vit B12) supplementations have been tried for lowering plasma homocysteine (Hcy) levels in uremic patients. However, the therapeutic potency of low-dose folic acid and Vit B12 alone is not properly understood. In this study, seventy-five patients on chronic hemodialysis (HD) therapy were randomized into three groups. The FNA group received intravenous (IV) supplementation with folinic acid 3 mg weekly; the Vit B12 group received IV supplementation with vitamin B12 1 mg weekly; and the combination group received IV supplementation with both agents weekly. Blood levels of Hcy, folic acid, and Vit B12 were measured monthly for three months. After three months of treatment, plasma levels of Hcy decreased significantly in all three groups when compared with their baselines (all p < 0.05). The final Hcy level was significantly lower in the combination group (11.5 +/- 2.3 micromol/L) when compared with that of the FNA group (15.9 +/- 5.6 micromol/L, p < 0.05) but not with the Vit B12 group (15.9 +/- 11.6 micromol/L), although their baseline levels were similar. The percentage decreases of tHcy at the end of the treatment in the FNA group, Vit B12 group, and combination group were 16.4%, 29.3%, and 38.9% respectively. Our study showed that IV pharmacologic dose of Vit B12 alone is as effective as low-dose folic acid in correcting hyperhomocysteinemia in chronic HD patients, and combining both drugs in low doses may have added effects.