Treatment of hyperhomocysteinemia in children on dialysis by folic acid

Adult patients with renal failure have a high total homocysteine concentrat ion in plasma. Hyperhomocysteinemia is an independent risk factor for cardi ovascular diseases. Folic acid lowers the homocysteine concentrations in pl asma in hyperhomocysteinemia. Whether this results in a reduced risk for ca rdiovascular diseases remains to be proven by intervention studies. In the present study we investigated: (1) if homocysteine concentrations are eleva ted in the plasma of children with renal failure and (2) the influence of f olic acid administration on the plasma homocysteine concentration. The plas ma homocysteine concentration was measured in 21 children, 9 on hemodialysi s and 12 on peritoneal dialysis, before and 4 weeks after treatment with 2. 5 mg folic acid daily. Healthy children (234) constituted the control group . In controls the median homocysteine concentration was 9.1 mu mol/l (range 4.3-20.0 mu mol/l). The median plasma homocysteine concentration in patien ts before folic acid treatment was 20.0 mu mol/l (Q1-Q3 13.7-26.0; Q, quart ile). After 4 weeks of folic acid treatment the median plasma homocysteine concentration was 12.0 mu mol/l [Q1-Q3 9.8-14.3 (P<0.0001 Wilcoxon signed r ank test)]. There was no significant difference between hemodialysis and pe ritoneal dialysis patients. Children with renal failure treated with hemodi alysis or peritoneal dialysis have elevated plasma homocysteine concentrati ons, but this is significantly reduced after administration of 2.5 mg folic acid daily for 4 weeks. It is suggested that folic acid be added to the tr eatment of children with renal failure, although a beneficial effect still has to be proven. The required dose needs further study.