Homocystein, Folate and Vitamin B12 levels in type 2 diabetic patients with various stage of chronic kidney disease

Background:a lowering effect of folate supplementation on homocysteine levels (tHcy)in patients with type2 diabetes mellitus (T2D) was recently demonstrated by Aghamohammadi V. and collaboratores (1),but no data on T2Dwith chronic kidney disease (CKD) were reported.Aim: Aim of the study is to determine tHcy levels in T2D patients at various stages of CKD and the relationship with folate and vitamin B12. Methods: we recruited 40 T2D-CKD patients (stages II-IV according to K-DOKI guidelines).tHcy levels were measured as previous described (2). Folate and vitamin B12 were assayed by an automated chemiluminescence system (Advia Centaur;Siemens).Results:tHcy levels increased in all patients, and this rise positively correlate with the CKD stage (p< 0,05). Moreover, we interestingly found that only in stage 2 CKD tHcy concentrations negatively correlates with low levels of both vitamin B12 and folate, whereas in stage 3 folate have no effect, and in stage 4 vitamin B12 have no effect on tHcy concentrations. Conclusion: we demonstrated for the first time that tHcy increase in diabetic CKD patients and this rise correlate positively with the stage of kidney disease. Folate and vitamin B12 levels have different effect on tHcy levels at different stages of CKD. These results may indicate the importance of the combined folate and vitamin B12 therapy at early stage of CKD, where the levels of tHcy negatively correlates with both folate and vitamin B12.