Effect of high-dose folic acid on hemodialysis patients with poor erythropoietin response

Erythropoietin (EPO) can improve the anemia of renal failure nlm may increa se the demand for-folic acid. The role of folic acid supplementation in dia lysis patients with anemia remains controversial. We investigated whether h igh-dose folic acid (HDFA) can improve EPO response and macrocytic anemia ( MCV greater than or equal to 100 fl) in hemodialysis (HD) patients with sev ere anemia. Seventeen HD patients 1 with renal anemia and poor EPO response (i.e., hematocrit less than or equal to 26% with subcutaneous EPO of 4,000 units per week) were I randomized into hire groups; one received 5 mg foli c acid orally thrice weekly (FA5 group), and the other received 20 mg folic acid orally thrice weekly (FA20 group). Hemoglobin, hematocrit, MCV, trans ferrin saturation and ferritin levels, folate levels of plasma and RBC, and plasma vitamin B-12 levels were measured and followed up. In the FA20 grou p, HDFA supplementation significantly increased the plasma and RBC folate l evels, but failed to reduce the EPO dosage or increase the hematocrit value . Seven patients (5 in the FA20 group and 1 in the FA5 group) presenting wi th macrocytic anemia were further analyzed. Their high MCV values did not i mprove following HDFA supplementation, There were no differences in clinica l parameters, folate levels of plasma and RBC, and plasma vita,min B-12 lev els between patients with and without macrocytic anemia. We conclude, there fore, that HDFA supplementation in HD patients does not improve the EPO res ponse, nor does it improve the MCV values in patients with macrocytic anemi a.