Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy
Article first published online: 22 OCT 2002
Journal of Internal Medicine
Volume 252, Issue 5, pages 456–464, November 2002
How to Cite
Apeland, T., Mansoor, M. A., Seljeflot, I., Brønstad, I., Gøransson, L. and Strandjord, R. E. (2002), Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy. Journal of Internal Medicine, 252: 456–464. doi: 10.1046/j.1365-2796.2002.01056.x
- Issue published online: 22 OCT 2002
- Article first published online: 22 OCT 2002
- Received 10 April 2002; revision received 25 July 2002; accepted 3 September 2002.
- endothelial activation;
- folinic acid;
- lipid peroxidation
Abstract. Apeland T, Mansoor MA, Seljeflot I, Brønstad I, Gøransson L, Strandjord RE (Rogaland Central Hospital, Stavanger; and Ullevål University Hospital, Oslo; Norway). Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy. J Intern Med 2002; 252: 456–464.
Objectives. Haemodialysis patients have elevated levels of the atherogenic amino acid homocysteine. We wanted to assess the effects of small doses of intravenous folinic acid (the active form of folic acid) on some biochemical risk factors of cardiovascular disease.
Design. Longitudinal and open intervention study.
Setting. Two dialysis units in the County of Rogaland.
Subjects. All patients on maintenance haemodialysis were invited, and 32 of 35 patients gave their informed consent.
Interventions. After each dialysis session, the patients were given 1.0 mg of folinic acid intravenously thrice a week for a period of 3 months. Prior to and during the study, all patients were on maintenance supplementation with small doses of vitamins B1, B2, B3, B5, B6 and B12.
Main outcome measures. Changes in the levels of (i) plasma total homocysteine (p-tHcy) and folate, (ii) circulating endothelium related proteins – markers of endothelial activation and (iii) serum malondialdehyde (S-MDA) – a marker of oxidative stress and lipid peroxidation.
Results. The p-tHcy levels were reduced by 37% (P < 0.0001), whilst the serum and erythrocyte folate levels increased by 95 and 104%, respectively (P < 0.0001 for both). The circulating levels of endothelium related cellular adhesion molecules and haemostatic factors remained high and unchanged, except the thrombomodulin (TM) levels increased (P = 0.0004). The high levels of S-MDA were reduced by 26% (P = 0.003).
Conclusions. Low doses of folinic acid given intravenously to dialysis patients reduced their levels of p-tHcy and S-MDA and thus improved their cardiovascular risk profile. The concurrent increment in TM levels was unexpected and of unknown clinical significance.