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
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.
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. ;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.
Nephrology, Renal Replacement Therapy.
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