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Effects of High-Dose Folic Acid and Pyridoxine on Plasma and Erythrocyte Sulfur Amino Acids in Hemodialysis Patients

MOHAMED E. SULIMAN^*, JOSÉ C. DIVINO FILHO, PETER BÀRÀNY^*, BJÖRN ANDERSTAM^*, BENGT LINDHOLM^* and JONAS BERGSTROM^*

^* Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Sweden.
Sophiahemmet Dialysis Unit, Stockholm, Sweden.

Correspondence to Dr. Jonas Bergström, Divisions of Baxter Novum and Renal Medicine, K-56, Huddinge University Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden. Phone: 46 87 462607; Fax: 46 87 114742; E-mail: jonaberg{at}kfcd05.hs.sll.se

Abstract. In this investigation, sulfur amino acids (sAA) and sulfhydryls were determined in the plasma and erythrocytes (RBC) of 10 uremic patients on regular hemodialysis (HD) treatment and 10 healthy subjects, before and after supplementation with 15 mg/d of folic acid and 200 mg/d of pyridoxine for 4 wk. The basal total plasma concentrations of homocysteine (Hcy), cysteine (Cys), cysteinylglycine (Cys-Gly), -glutamylcysteine (-Glu-Cys), glutathione (GSH), and free cysteinesulfinic acid (CSA) were significantly higher in HD patients when compared to healthy subjects, whereas methionine (Met) and taurine (Tau) concentrations were the same in the two groups. HD patients showed significantly higher RBC levels of Hcy and Cys-Gly, whereas the RBC concentrations of Met, Cys, Tau, and GSH were not different from those in the healthy subjects. The plasma concentrations of sAA and sulfhydryls differed compared with RBC levels in the healthy subjects and HD patients. In both groups, supplementation with high doses of folic acid and pyridoxine reduced the plasma Hcy concentration. In addition, increased plasma concentrations of Cys-Gly and GSH were found in the HD patients and of CSA in the healthy subjects. After vitamin supplementation, the RBC concentrations of Hcy, Cys, and GSH increased and that of Tau decreased in healthy subjects. The only significant finding in RBC of HD patients was an increase in GSH levels after supplementation. This study shows several RBC and plasma sAA and sulfhydryl abnormalities in HD patients, which confirms earlier findings that RBC and plasma pools play independent roles in interorgan amino acid transport and metabolism. Moreover, high-dose supplementation with folic acid and pyridoxine significantly reduced Hcy levels, but did not restore the sAA and sulfhydryl abnormalities to normal levels. The increase that was observed in GSH after vitamin supplementation may have a beneficial effect in improving blood antioxidant status in uremic patients. Finally, the findings of elevated plasma Cys levels correlating to the elevated plasma Hcy levels in the presence of elevated plasma CSA levels, both before and after vitamin supplementation, led to the hypothesis that a block in decarboxylation of CSA is linked to hyperhomocysteinemia in end-stage renal failure.

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