To the Editor The Original Investigation by Xu et al1 in a recent issue of JAMA Internal Medicine convincingly shows that folic acid supplementation can slow the progression of chronic kidney disease (CKD). In their study, Xu et al hypothesize that the protective effect of folic acid may be mediated by a reduction in homocysteine levels that are frequently high in patients with CKD and are associated with CKD progression. The results of this study, however, should be interpreted keeping in mind that folic acid may exert an antioxidant effect independent of the reduction in homocysteine concentration.
Pedone C, Incalzi RA. The Nephroprotective Effect of Folic Acid—Only a Matter of Homocysteine? JAMA Intern Med. 2017;177(2):285–286. doi:https://doi.org/10.1001/jamainternmed.2016.8580
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