1. Home
  2. Vol 53, No 3 (2021)
  3. Lydia

The Relationship between Folic Acid and Vitamin B12 Serum Levels with High Sensitivity C-reactive Protein and Homocysteine in Chronic Hemodialysis Patients: A Cross-sectional Study

Aida Lydia, Dimas Priantono, Kuntjoro Harimurti, Idrus Alwi

Abstract


Background: Folic acid (FA) and vitamin B12 treatment have been routinely prescribed to lower serum homocysteine levels and to reduce inflammation. However, no study has been conducted to determine serum folic acid (SFA) and vitamin B12 (B12) levels in patients who have twice-weekly hemodialysis. The aim of our study was to assess serum folate and B12  levels in chronic hemodialysis patients and their relationship with hsCRP and homocysteine levels. Methods: Our study was a cross-sectional study involcing patients who had twice-weekly hemodialysis in Dr Cipto Mangunkusumo National Hospital Jakarta, Indonesia. Predialysis blood samples were taken to measure SFA, B12, homocysteine and hsCRP levels. Patients with medical conditions affecting the assays were excluded. Spearman correlation was used to compare variables. Results: Eighty subjects enrolled in this study. Among those of non-given folic acid and vitamin B-12 supplementation, only 3.85% of subjects had low folic acid levels, and none had low vitamin B12 levels. A moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.42) and a weak correlation between serum vitamin B12 and homocysteine level (p=0.009; r=-0.29) was found. Among the high-risk cardiovascular group (CRP>3, n=49), there is a moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.561) and a weak negative correlation between vitamin B12 and homocysteine level (p=0.018; r=-0.338). Conclusion: There is a significant negative correlation between serum vitamin B12 and folic acid with homocysteine levels, especially in high-risk cardiovascular group.

Keywords


Folic acid; vitamin B12; cardiovascular; mortality; morbidity; hsCRP; CKD; chronic hemodialysis

References


Xu X, Qin X, Li Y, et al. Efficacy of folic acid therapy on the progression of chronic kidney disease: the renal substudy of the china stroke primary prevention trial. JAMA Intern Med 2016;176(10):1443-50. doi: 10.1001/jamainternmed.2016.4687

Azalea M, Andayani TM, Satibi. Analisis biaya pengobatan penyakit ginjal kronis rawat inap dengan hemodialisis di rumah sakit. Jurnal Manajemen dan Pelayanan Farmasi 2016;6(2):141-50.

Suhardjono. Hemodialisis: prinsip dasar dan pemakaian kliniknya. In: Setiati S, Alwi I, Sudoyo AW, et al., eds. Buku Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing 2014:2192-96.

Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. The Lancet 2013;382(9888):260-72. doi: 10.1016/s0140-6736(13)60687-x

Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999;10:1606-15.

Team IRR. 10th report of Indonesian renal registry. Jakarta: Indonesian Renal Registry, 2018.

Nand M, Sharma M, Mittal N. Prevalence of hyperhomocysteinaemia in chronic kidney disease and effect of supplementation of folic acid and vitamin B12 on cardiovascular mortality. JIACM 2013;14(1):33-36.

Tamadon MR, Jamshidi L, Soliemani A, et al. Effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis. Iran J Kidney Dis 2011;5(2):93-96.

Qin X, Huo Y, Langman CB, et al. Folic acid therapy and cardiovascular disease in ESRD or advanced chronic kidney disease: a meta-analysis. Clin J Am Soc Nephrol 2011;6(3):482-8. doi: 10.2215/CJN.05310610

Amini M, Khosravi M, Baradaran HR, et al. Vitamin B12 supplementation in end stage renal disease: a systematic review. MJIRI 2015;29(167):1-8.

Bazeley J, Bieber B, Li Y, et al. C-reactive protein and prediction of 1-year mortality in prevalent hemodialysis patients. Clin J Am Soc Nephrol 2011;6(10):2452-61. doi: 10.2215/CJN.00710111

Li Y, Zhong X, Cheng G, et al. Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: A meta-analysis. Atherosclerosis 2017;259:75-82. doi: 10.1016/j.atherosclerosis.2017.02.003

Hwang YC, Morrow DA, Cannon CP, et al. High-sensitivity C-reactive protein, low-density lipoprotein cholesterol and cardiovascular outcomes in patients with type 2 diabetes in the EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial. Diabetes Obes Metab 2018;20(3):654-59. doi: 10.1111/dom.13136

Hassan K. Association of low potassium diet and folic acid deficiency in patients with CKD. Ther Clin Risk Manag 2015;11:821-7. doi: 10.2147/TCRM.S83751

Jamison RL, Hartigan P, Kaufman JS, et al. Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: A randomized controlled trial. JAMA 2007;298(10):1163-70. doi: 10.1001/jama.298.10.1163

Jardine MJ, Kang A, Zoungas S, et al. The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis. BMJ 2012;344:e3533. doi: 10.1136/bmj.e3533

Wrone EM. Randomized Trial of Folic Acid for Prevention of Cardiovascular Events in End-Stage Renal Disease. Journal of the American Society of Nephrology 2004;15(2):420-26. doi: 10.1097/01.asn.0000110181.64655.6c

Chang TY, Chou KJ, Tseng CF, et al. Effects of folic acid and vitamin B complex on serum C-reactive protein and albumin levels in stable hemodialysis patients. Curr Med Res Opin 2007;23(8):1879-86. doi: 10.1185/030079907X218077

Heinz J, Kropf S, Domrose U, et al. B vitamins and the risk of total mortality and cardiovascular disease in end-stage renal disease: results of a randomized controlled trial. Circulation 2010;121(12):1432-8. doi: 10.1161/CIRCULATIONAHA.109.904672

Righetti M, Serbelloni P, Milani S, et al. Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients. Blood Purif 2006;24(4):379-86. doi: 10.1159/000093680

Righetti M, Ferrario G, Milani S, et al. Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients. Med Sci Monit 2003;9(4):37-42.

Vianna ACA, Mocelin AJ, Matsuo T, et al. Uremic hyperhomocysteinemia: A randomized trial of folate treatment for the prevention of cardiovascular events. Hemodial Int 2007;11(2):210-16. doi: doi:10.1111/j.1542-4758.2007.00171.x

Trimarchi H, Schiel A, Freixas E, et al. Randomized trial of methylcobalamin and folate effects on homocysteine in hemodialysis patients. Nephron 2002;91:58-63.

Hulley SB, Cummings SR, Browner WS, Grady D, Newman TB. Designing clinical research : an epidemiologic approach. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013. Appendix 6C, page 79

Fehrman-Ekholm I, Lotsander A, Logan K, et al. Concentrations of vitamin C, vitamin B12 and folic acid in patients treated with hemodialysis and on-line hemodiafiltration or hemofiltration. Scand J Urol Nephrol 2008;42(1):74-80. doi: 10.1080/00365590701514266

Information NCfB. Vitamin B12, CID=25102581. PubChem Database, 2019.

Azar A, Canaud B. Hemodialysis system. In: Azar AT, ed. Modelling and control of dialysis systems. Berlin: Springer-Verlag 2013:99-166.

Clase CM, Ki V, Holden RM. Water-soluble vitamins in people with low glomerular filtration rate or on dialysis: a review. Semin Dial 2013;26(5):546-67. doi: 10.1111/sdi.12099

Soohoo M, Ahmadi SF, Qader H, et al. Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients. Nephrol Dial Transplant 2017;32(6):1024-32. doi: 10.1093/ndt/gfw090

Yousuf O, Mohanty BD, Martin SS, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol 2013;62(5):397-408. doi: 10.1016/j.jacc.2013.05.016

Pastore A, Angelis SD, Casciani S, et al. Effects of folic acid bfore and after vitamin B12 on plasma homocysteine concentrations in hemodialysis patients with known MTHFR genotypes. Clin Chem 2006;52(1):145-48.


Full Text: PDF

Refbacks

  • There are currently no refbacks.