Ag. Bostom et al., TREATMENT OF HYPERHOMOCYSTEINEMIA IN RENAL-TRANSPLANT RECIPIENTS - A RANDOMIZED, PLACEBO-CONTROLLED TRIAL, Annals of internal medicine, 127(12), 1997, pp. 1089-1092
Background: Stable renal transplant recipients have an excess prevalen
ce of hyperhomocysteinemia, which is a risk factor for arteriosclerosi
s. Objective: To determine the effect of treatment with 1) vitamin B-6
or 2) folic acid plus vitamin B-12 on fasting and post-methionine-loa
ding plasma total homocysteine levels in renal transplant recipients.
Design: Block-randomized, placebo-controlled, 2x2 factorial study. Set
ting: University-affiliated transplantation program. Patients: 29 clin
ically stable renal transplant recipients. Intervention: Patients were
randomly assigned to one of four regimens: placebo (n = 8); vitamin B
-6, 50 mg/d (n = 7); folic acid, 5 mg/d, and vitamin B-12, 0.4 mg/d (n
= 7); or vitamin B-6, 50 mg/d, folic acid, 5 mg/d, and vitamin B-12,
0.4 mg/d (n = 7). Measurements: Pasting and 2-hour post-methionine-loa
ding plasma total homocysteine levels. Results: Vitamin B-6 treatment
resulted in a 22.1% reduction in geometric-mean post-methionine-loadin
g increases in plasma total homocysteine levels (P = 0.042), and folic
acid plus vitamin B-12 treatment caused a 26.2% reduction in geometri
c-mean fasting plasma total homocysteine levels (P = 0.027). These res
ults occurred after adjustment for age; sex; and pretreatment levels o
f total homocysteine, B vitamins, and creatinine. Conclusions: Vitamin
B-6 should be added to the combination of folic acid and vitamin B-12
for effective reduction of both post-methionine-loading and fasting p
lasma total homocysteine levels in renal transplant recipients.