A controlled trial of the effect of folate supplements on homocysteine, lipids and hemorheology in end-stage renal disease

Elevated plasma homocysteine (Hcy), dyslipidemia and hemorheological abnorm alities all occur commonly in end-stage renal disease (ESRD) and are recogn ized risk factors for arteriosclerosis. To study the effect of folate suppl ementation on these factors we conducted a randomized controlled trial. Thi rteen hemodialysis (HD) and 8 continuous ambulatory peritoneal dialysis (CA PD) patients received either 5 mg folic acid daily or placebo for 3 months. After 1 and 3 months, fasting blood samples were taken for Hey, lipid prof ile, blood and plasma viscosity, red blood cell (RBC) osmotic fragility, pl asma fibrinogen concentration and in vivo platelet aggregability. At baseli ne, the CAPD patients had a higher mean plasma fibrinogen concentration tha n the HD patients and they also tended to have higher mean plasma viscosity . Folate-treated patients showed marked increases in RBC folate and an aver age decrease in plasma Hey concentration of 33%. Mean total cholesterol, LD L cholesterol and triglyceride concentrations decreased significantly in th e CAPD patients who took folate. Folate had no significant effect on hemorh eology. In conclusion, folate supplements in ESRD reduce plasma Hey concent rations and may improve lipid profiles. In our patients, hemorheological ab normalities were more marked in patients on CAPD than in those on HD and we re not improved by folate supplementation. Copyright (C) 2000 S. Karger AG, Basel.