Folic Acid Supplementation and Cardiac and Stroke Mortality Among Hemodialysis Patients

Objective: We sought to assess whether the use of folic acid vitamin supplements reduced cardiac and stroke mortality in hemodialysis patients. Further, we examined whether the consumption of folic acid from vitamin supplements >1000 microg compared with the standard 1000 microg, and 1000 microg compared with either a lower dose or no consumption, were associated with reduced cardiac and stroke mortality risk.

Design: We performed a secondary analysis of data from the Hemodialysis Study, a randomized clinical trial examining dialysis treatment regimens over a 3-year follow-up.

Participants: Participants included 1846 hemodialysis patients previously participating in the Hemodialysis Study.

Interventions: There were no interventions.

Main Outcome Measure: Cardiac and stroke mortality were our main outcome measures.

Results: Based on time-dependent Cox proportional hazard regression models, folic acid consumption from vitamin supplements, above or below the standard 1000-microg dose, was not associated with a decrease or increase in cardiac mortality (P = .53, above vs. standard dose; P = .46, below vs. standard dose). There was also no association between folic acid consumption and mortality from stroke (P = .27, above vs. standard dose; P = .64, below vs. standard dose).

Conclusion: The consumption of higher than the standard 1000-microg prescribed dose of folic acid was not beneficial in reducing cardiac or stroke mortality in hemodialysis patients. Similarly, the consumption of less than the standard dose was not associated with an increase in either cardiac or stroke mortality.