In Reply: In response to Dr van Guldener,
studies have shown that maximum reduction of plasma homocysteine in patients with chronic renal disease requires a daily dose of folic acid greater than 1 mg. For example, Wrone et al1 studied the effect on 3 groups of dialysis patients treated daily with 1 mg, 5 mg, or 15 mg of folic acid. At 18 months, the reductions in plasma homocysteine levels were 3.7,
4.3, and 10.2 μmol/L, respectively.
Jamison RL, Guarino PD, Goldfarb DS, Warren SR. Homocysteine Lowering and Severe Kidney Disease—Reply. JAMA. 2008;299(3):287-288. doi:10.1001/jama.299.3.288