مقايسه تجويز كم تر از ميلي گرم روزانه با 15 ميلي گرم يك روز در ميان اسيدفوليك دركاهش هيپرهموسيستيينمي بيماران همودياليزي

A randomized Study of Folic acid Therapy with less than 5 mg/day and 7.5 mg/day in Hyperhomocysteinemic Hemodialysis Patients

Background and purpose: Hyperhomocysteinemia is common among patients with renal failure and the risk of cardiovascular diseases increases with hyperhomocysteinemia. The aim of this study was to compare the efficacy of two doses of folic acid (2 and 7.5 mg/day) in decreasing plasma concentration of homocysteine in ESRD patients receiving regular hemodialysis therapy. Materials and methods : In this randomized trial, 14 hemodialysis patients were enrolled according to prestudy homocysteine level in Imam Khomeini hospital in July 2003. They had been treated with 1-5 mg/day folic acid with pyridoxine and then received 15 mg every other day folic acid with duration of at least two months. After the first and second month of treatment, blood samples were assessed for homocysteine and hemoglobin concentration, albumin, HDL and LDL. Patients were assessed for folic acid complications especially nausea and dizziness. Results : The mean age and hemodialysis were 50.92+18.6 and5.28±4.25 years respectively. The homocysteine level with higher dose of folic acid were significantly lower than with lower dose (23.98±6.87 vs. 33.89±16.28 µmol/L respectively, P=0.008). There was also a significant increase in plasma albumin concentration in high dose period compared to low dose period (4.75±0.94 vs. 4.32+0.30 gr/dL respectively, P=0.004). There were no significant differences between hemoglobin concentration, HDL and LDL with different doses. No side effect was noted among patients during treatment periods. Conclusion: This study showed 15 mg every other day folic acid in hemodialysis patients was associated with greater dent of homocysteine level than doses less than 5mg/d. According to the relationship between cardiovascular events, cerebral vein thrombosis and high plasma levels of homocysteine, better correction of it is necessary. In conclusion we recommend that this dose may be more beneficial to hemodialysis patients.