Folate measurements in patients on regular hemodialysis treatment

Patients on regular hemodialysis treatment may develop megaloblastic anemia caused by folate deficiency, but whether folate supplementation is require d is still controversial, particularly during erythropoietin administration , Erythrocyte folate concentration is a better indicator of folate status t hen serum folate, although the latter is the variable generally measured, W e measured serum and erythrocyte folate in blood samples from 112 regular h emodialysis patients (57 men, 55 women, 50 treated with erythropoietin, and 62 not) by Stratus Folate immunoenzymatic assay (Dade), Patients with very low serum (<2.87 ng/mL) but normal erythrocyte folate were reinvestigated 4 months later without receiving folate supplementation meanwhile, Serum fo late concentrations were 0.48 to 12.76 ng/mL (median, 3.40) and erythrocyte folate 0.19 to 1.85 mu g/mL (median, 0.42), Only 37% serum folate values w ere in the relevant reference interval compared with 80.2% erythrocyte fola te values (3.08 to 17.65 ng/mL end 0.24 to 0.64 mu g/mL, respectively), A s ignificant correlation was found between serum and erythrocyte folate conce ntrations, without clinical relevance caused by the wide scatter around the regression line. Serum end erythrocyte folate did not vary significantly b etween patients given erythropoietin and those not so treated, The folate s tatus of the 24 patients with very low serum folate was almost unchanged 4 months later. According to the serum folate test, 63% of patients needed fo late supplementation, whereas the erythrocyte folate test, a better indicat or of folate status, suggested that only 1.8% of patients needed folate sup plementation. Erythropoietin therapy appears not to be an indication for st andard folate supplementation in hemodialysis patients, (C) 1999 by the Nat ional Kidney Foundation, Inc.