Does Oral Folic Acid Lower Total Homocysteine Levels and Improve Endothelial Function in Children With Chronic Renal Failure?

K. Bennett-Richards
2002 Circulation  
Background-Accelerated vascular disease is common in chronic renal failure (CRF) and accounts for significant mortality and morbidity. Elevated homocysteine levels may contribute by an effect on endothelial function. Methods and Results-We performed a double-blind placebo-controlled randomized crossover trial of folic acid at 5 mg/m 2 in 25 normotensive children 12Ϯ3 (7 to 17) years of age with CRF (glomerular filtration rate 26.8Ϯ13.2 mL/min per 1.73 m 2 ) of noninflammatory etiology. Each
more » ... etiology. Each subject underwent two 8-week periods of folic acid and placebo separated by an 8-week washout period. The effect of folic acid on homocysteine levels, LDL oxidation, and both endothelial-dependent and -independent vascular function were measured. After oral folic acid, serum folate levels rose from 11.7Ϯ4.25 to 635Ϯ519 g/L (Pϭ0.001), red cell folate levels rose from 364Ϯ195 to 2891Ϯ2623 g/L (PϽ0.001), and total homocysteine levels fell from 10.28Ϯ4.16 to 8.62Ϯ2.32 mol/L (Pϭ0.03). In addition, there was a significant improvement in flow-mediated dilatation (FMD) (endothelial-dependent dilatation) from 7.21Ϯ2.8% to 8.47Ϯ3.01% (Pϭ0.036) with no change in response to glyceryl trinitrate (endothelial-independent dilatation). There was no significant change in FMD or glyceryl trinitrate during the placebo phase. There was, however, no significant difference in final FMD after placebo or folic acid. Lag times for LDL oxidation were prolonged during the treatment phase (58.4Ϯ18.7 to 68.1Ϯ25.9 minutes, Pϭ0.01). Conclusion-Folic acid supplementation in children with CRF may improve endothelial function with an increased resistance of LDL to oxidation. (Circulation. 2002;105:1810-1815.)
doi:10.1161/01.cir.0000014417.95833.1d pmid:11956124 fatcat:e7jpokijgzdynkrgllpnvs5fwa