Is folate a promising agent in the prevention and treatment of cardiovascular disease in patients with renal failure?

Kidney International
An S De VrieseNorbert H Lameire

Abstract

Management of the conventional cardiovascular risk factors is insufficient to prevent the dramatic increase in atherosclerotic cardiovascular morbidity and mortality in patients with renal failure. Folate recently received attention as a potential alternative treatment option to decrease the excess cardiovascular risk in the uremic population. Folate administration is the principal treatment modality for hyperhomocysteinemia. Hyperhomocysteinemia is prevalent in more than 85% of patients with end-stage renal disease (ESRD) and is independently associated with increased odds for atherosclerotic cardiovascular disease. Several attempts have been made to normalize homocysteine levels in uremic patients with folate-based vitamin regimens. Although supraphysiologic doses of folic acid afford greater reductions in homocysteine levels than standard doses, the response to treatment is generally only partial and the large majority of ESRD patients have residual hyperhomocysteinemia. Several defects in folate metabolism have been described in uremia, which may explain the relative folate resistance in patients with renal failure, but their clinical relevance remains uncertain. It appears unlikely that the hyperhomocysteinemia in ESRD can...Continue Reading

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Citations

Sep 13, 2003·Kidney International·Youri E C TaesNorbert H Lameire
Dec 13, 2003·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Ton J Rabelink
Nov 8, 2003·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·An S De VrieseErvé Matthys
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Feb 16, 2006·The American Journal of the Medical Sciences·Cherng Zee ChuangAlfredo Lopez-S
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Dec 11, 2007·The American Journal of Clinical Nutrition·Conrad Wagner, Mark J Koury
Nov 14, 2002·Seminars in Nephrology·James PaparelloDaniel Batlle

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