Dietitians of Canada

Elevated plasma total homocysteine (p tHcy) or hyperhomocysteinemia (hHcy) is an independent risk factor for cardiovascular disease and is more prevalent in people with predialysis chronic kidney disease (pCKD) than in the general population. The mechanism underlying hHcy in pCKD is not clearly defined but its’ determinants include renal function, as well as folate, vitamin B12 and vitamin B6 status. To our knowledge there is no published data describing the prevalence of hHcy in pCKD after folic acid food fortification (FF) of the Canadian food supply (1998) nor have the dietary intake of folate, B12 and B6 been assessed in this population. Inadequate dietary intake may be prevalent due to gastrointestinal (GI) symptoms of uremia in pCKD. The objectives of this study are 1) to determine the prevalence of hHcy and 2) to assess the adequacy of dietary folate, B12 and B6, protein and energy intake in people with pCKD. We hypothesize that the prevalence of hHcy remains high (75%), despite FF, and that the majority of patients have inadequate intake of the above nutrients from food perhaps due to GI symptoms of uremia. Newly referred pCKD patients (n=72) will be consecutively recruited from two predialysis clinics. Dietary intakes will be assessed using the 5 pass repeat 24-hour dietary recall method and a fasting blood sample will be taken for determination of p tHcy, RBC folate and serum folate, B12 and B6. Considered in relation to vitamin status, this study`s findings on the prevalence of hHcy and adequacy of folate, B12 and B6 intakes in pCKD patients in the era following FF are expected to help guide dietetic practice regarding the need for vitamin supplementation in this population.