INFLUENCE OF DIALYSIS TECHNIQUES AND ALTERNATE VITAMIN SUPPLEMENTATION ON HOMOCYSTEINEMIA LEVELS IN PATIENTS WITH KNOWN MTHFR GENOTYPES:

Background: The aims of the present study were to investigate the effects of an alternate vitamin supplementation on total homocysteine (tHcy) plasma levels in HD patients, to compare changes in tHcy levels with MTHFR genotype and to value the micronutrients loss induced by different dialysis techniques. Methods: 74 patients, 44 men and 30 women, were recruited and randomized blindly into two groups of 37 subjects each. The 1st group was initially treated with vitamin B12 for two months and with folic acid for the following two months; the 2nd group initially with folate and then with vitamin B12. For both groups, a wash out period of 2 months followed the treatment. tHcy plasma levels were determined at the start of treatment (T0), after two months (T1), four months (T2) and at the end of the wash out period (T3). Vitamin B12 and folate were measured at the T0 and T3. Results. Hcy decreased in both groups following the alternate vitamins therapy. This decrease was greater for the T/T genotype (p<0.05) and was more significant when the treatment started with folic acid (p< 0.01). Moreover, after the wash out period, Hcy increased remarkably without significative differences between diffusive and convective techniques. Folate levels at the end of study, showed a higher reduction with hemodialysis compared to hemodialfiltration. The Vitamin B12concentration significantly increased in patients on diffusive hemodialysis, confirming a decisive role of membrane performance.