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Treatment of Hyperhomocysteinemia in Renal Transplant Recipients: A Randomized, Placebo-Controlled Trial

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; and Irwin H. Rosenberg, MD
[+] Article, Author, and Disclosure Information

From The Jean Mayer USDA Human Nutrition Research Center, Boston, Massachusetts; Rhode Island Hospital, Providence, Rhode Island; and Memorial Hospital of Rhode Island, Pawtucket, Rhodc Island. Acknowledgments: The authors thank R&D Laboratories; Dr. Rhoda Makoff, for supplying the vitamin and placebo capsules; and Ms. Evelyn Tolbert, for technical support. Grant Support: By a discretionary grant to Dr. Bostom from the Massachusetts/Rhode Island Affiliate of The National Kidney Foundation. Requests for Reprints: Andrew G. Bostom, MD, MS, Department of General Internal Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860. Current Author Addresses: Dr. Bostom: Department of General Internal Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(12):1089-1092. doi:10.7326/0003-4819-127-12-199712150-00006
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Background: Stable renal transplant recipients have an excess prevalence of hyperhomocysteinemia, which is a risk factor for arteriosclerosis.

Objective: 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.

Design: Block-randomized, placebo-controlled, 2 × 2 factorial study.

Setting: University-affiliated transplantation program.

Patients: 29 clinically stable renal transplant recipients.

Intervention: 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).

Measurements: Fasting and 2-hour post-methionine-loading plasma total homocysteine levels.

Results: 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.

Conclusions: 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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