To the Editor: Dr Jamison and colleagues1
described the results of the Homocysteinemia in Kidney and End Stage Renal Disease (HOST) study, a randomized trial of homocysteine lowering and mortality and vascular disease in patients with severe kidney disease. One of the important rationales behind the HOST trial was that patients with severe chronic kidney failure have substantially elevated plasma homocysteine concentrations.2
Folic acid–based treatments are effective in reducing homocysteine levels in patients with kidney disease, but normalization of homocysteine is rare.3
Patients undergoing dialysis who do not use B-vitamin supplements have homocysteine levels of about 30 to 45 μmol/L, and treatment with as little as 1 mg/d reduces this level to about 20 to 25 μmol/L,4,5 the baseline level in the HOST trial.
van Guldener C. Homocysteine Lowering and Severe Kidney Disease. JAMA. 2008;299(3):287–288. doi:10.1001/jama.299.3.287-b