PERBANDINGAN EFEKTIFITAS ASAM FOLAT DOSIS STANDAR DENGAN DOSIS TINGGI TERHADAP HIPERHOMOSISTEINEMIA PADA GAGAL GINJAL DENGAN HEMODIALISIS REGULER

Abstract

Prevalence of hyperhomocysteinemia(HHcy) in regularly hemodialysis chronic kidney disease (RHDCKD) is high.
HHcy in RHD CKD related to atherosclerosis an increase risk of cardiovascular disease. Increasing 5 ?mol/L of Hcy level from
10?mol/L correlate with increasing 60% cardiovascular risk in male and 80% in female and also increasing 50% risk of stroke
both in male and female. Folic acid, vitamin B 12 and vitamin B 6 is needed to decrease Hcy level according homocysteine trialyst
lowering collaboration (HTLC), folic acid may decrease the Hcy level by 25%, vitamin B 12 7% but no significance effect of
vitamin B 6. Standard dose of folic acid 2-5 mg/day may normalized HHcy in predialysis CKD but most of RHDCKD fail to
reach normal level. Treatment result of RHDCKD before is varied and inconsistent. This study was randomized double blind
controlled clinical trial aimed to know whether higher dose of folic acid decreased Hcy greater than standard dose, that using 15
mg/day compare to 5 mg/day of folic acid treatment for 4 weeks RHDCKD with hyperhomocysteinemia. Thirty patients were
recruited base on exclusion and inclusion criteria and two weeks standardization using 1 mg/day folic acid was performed.
Complete blood count, lipid profile, blood sugar, albumin and globulin, BUN, creatinine serum, SGPT/SGOT and Hcy were
examined in the beginning of the study and after 4 weeks. Permuted block randomization was done among participant in order to
grouping them into 15 mg/day and 5 mg/day folic acid group. Compare means of decreased Hcy in each group as primary
outcome was analyzed using student t test, 95% confidence interval (CI) , p<0,05. During study, 15 patients were treated with 15
mg/day folic acid and 13 patients with 5 mg/day folic acid. Increased of Hcy was 1,00±4,11 ?Mol/L among 15 mg/day folic acid
group (20,67 ±6,69 ?Mol/L increased to 21,68±4,59 ?Mol/L ) and 1,93±3,40 ?Mol/L (18,77±5,38 increased to
21,00±5,24?Mol/L) among 5 mg /day folic acid group, CI 95% -2,03 to 3,88, p = 0,53. ANCOVA analyzed of other variables
effect such as BMI, blood sugar, age and sex on Hcy level was not found. We conclude that 15 mg/day comparing to 5 mg/day
folic acid is not more effective in decreasing Hcy level of regularly hemodialysed patient with hyperhomocysteinemia.