Document Detail

Role of folate deficiency on erythropoietin resistance in pediatric and adolescent patients on chronic dialysis.
MedLine Citation:
PMID:  16133045     Owner:  NLM     Status:  MEDLINE    
Unlike iron therapy, folate use is not a standard of care in hemodialysis (HD) patients. Despite iron repletion, poor response to erythropoietin (EPO) treatment is common. Theoretical evidence for folate deficiency (FD) includes chronic blood loss, inflammation, malnutrition, and nutrient loss during dialysis. Due to poor diagnostic standards, early studies failed to establish a role for FD in EPO resistance. Given that hematological response to therapeutic intervention is the gold standard for FD, its diagnosis was therefore based on composite scoring of RBC and/or folate indices. Fifteen subjects (8-20 years) on chronic HD were enrolled in this study. No folate supplement was given in the first six months. Thereafter, 5-mg folic acid was administered orally after HD sessions over a six-month period. Folate indices before and after treatment were compared using percentage differences and paired t-tests. After folate use, the mean Hb increased by 11.4%, while MCV and RDW were reduced. Similarly, 4 of the 15 subjects each had a > or = 20% rise in Hb and a > or = 5% reduction in MCV, while 46.7% had a > or = 2.5% reduction in RDW. Mean RBC folate increased by 24%, while FD scores reduced from 3.8+/-1.2 to 0.4+/-0.7, and the EPO requirement by 90%. In contrast to previous studies, 26.7% of study subjects met the criteria for FD. Furthermore, the substantial (post-folate) reduction in the EPO requirement validates the need for therapeutic intervention, and therefore the presence of functional FD in the population.
Oluwatoyin Fatai Bamgbola; Frederick Kaskel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2005-08-20
Journal Detail:
Title:  Pediatric nephrology (Berlin, Germany)     Volume:  20     ISSN:  0931-041X     ISO Abbreviation:  Pediatr. Nephrol.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-06     Completed Date:  2006-03-29     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8708728     Medline TA:  Pediatr Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1622-9     Citation Subset:  IM    
Department of Pediatrics, Oklahoma University Health Science Center, 940 13th Street, Rm 2B2309, Oklahoma City, OK 73104, USA.
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MeSH Terms
Anemia, Iron-Deficiency / blood,  complications,  drug therapy*
Drug Resistance
Erythropoietin, Recombinant / therapeutic use*
Folic Acid / blood,  therapeutic use
Folic Acid Deficiency / blood,  complications*,  diagnosis,  drug therapy
Hemoglobins / analysis
Kidney Failure, Chronic / complications*,  therapy
Renal Dialysis* / adverse effects
Vitamin B 12 / blood
Grant Support
9-526-3740//PHS HHS
Reg. No./Substance:
0/Erythropoietin, Recombinant; 0/Hemoglobins; 59-30-3/Folic Acid; 68-19-9/Vitamin B 12

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