Andrew G. Bostom, MD, MS; Reginald Y. Gohh, MD; Andrew J. Beaulieu, MD; Marie R. Nadeau, MS; Anne L. Hume, PharmD; Paul F. Jacques, ScD; Jacob Selhub, PhD; Irwin H. Rosenberg, MD
Bostom AG, Gohh RY, Beaulieu AJ, Nadeau MR, Hume AL, Jacques PF, et al. Treatment of Hyperhomocysteinemia in Renal Transplant Recipients: A Randomized, Placebo-Controlled Trial. Ann Intern Med. 1997;127:1089-1092. doi: 10.7326/0003-4819-127-12-199712150-00006
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Published: Ann Intern Med. 1997;127(12):1089-1092.
Stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia, which is a risk factor for arteriosclerosis.
To determine the effect of treatment with 1) vitamin B6 or 2) folic acid plus vitamin B12 on fasting and post-methionine-loading plasma total homocysteine levels in renal transplant recipients.
Block-randomized, placebo-controlled, 2 × 2 factorial study.
University-affiliated transplantation program.
29 clinically stable renal transplant recipients.
Patients were randomly assigned to one of four regimens: placebo (n = 8); vitamin B6, 50 mg/d (n = 7); folic acid, 5 mg/d, and vitamin B12, 0.4 mg/d (n = 7); or vitamin B6, 50 mg/d, folic acid, 5 mg/d, and vitamin B12, 0.4 mg/d (n = 7).
Fasting and 2-hour post-methionine-loading plasma total homocysteine levels.
Vitamin B6 treatment resulted in a 22.1% reduction in geometric-mean post-methionine-loading increases in plasma total homocysteine levels (P = 0.042), and folic acid plus vitamin B12 treatment caused a 26.2% reduction in geometric-mean fasting plasma total homocysteine levels (P = 0.027). These results occurred after adjustment for age; sex; and pretreatment levels of total homocysteine, B vitamins, and creatinine.
Vitamin B6 should be added to the combination of folic acid and vitamin B12 for effective reduction of both post-methionine-loading and fasting plasma total homocysteine levels in renal transplant recipients.
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Nephrology, Renal Replacement Therapy.
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