To the Editor We read with great interest the Original Investigation by Xu et al1 published in a recent issue of JAMA Internal Medicine. In this study, Xu et al demonstrated that low-dose folic acid treatment in addition to enalapril in patients with hypertension without prior cardiovascular events reduced the incidence and progression of chronic kidney disease (CKD) compared with treatment with enalapril alone. Although the mechanism of this effect remains to be proven, decreases in plasma homocysteine are a potential explanation.1
Cabrera S, Alvo M, Ferro C. The Nephroprotective Effect of Folic Acid—Only a Matter of Homocysteine? JAMA Intern Med. 2017;177(2):286. doi:https://doi.org/10.1001/jamainternmed.2016.8583
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