Normalization of homocysteine in dialysis patients by directed repletion, with apparent reduction of access thrombosis

This report describes the first study in which all members of a group of di alysis patients had their homocysteine levels reduced into the normal range . The method utilized a lymphocyte transformation analysis to identify spec ific deficiences in vitamns B-6 and B-12 follic acid minerals, glutathione and antioxidant function at the functional intracellular level. A supplemen tation program based on the results was designed for individual patients an d consisted of N-acetylcysteine plus varying dosage of specific micronutien ts that were determined to be functionally deficient. Within 12 weeks, the individualized treatment was found to reduce serum homocysteine levels were found to remain low for at least an additional 25 weeks. It was observed t hat venous acces thrombotic episodes were reduced by more than 50% during t he 6 months following normalization of homocysteine concentrations. This ap pears to be the first reported instance of a direct physiological benefit a ssociated with homocysteine reduction in dialysis patients.