Folic Acid May Reduce Progression of Chronic Kidney Disease Interview with:
Fan Fan Hou Chief, Division of Nephrology, Nanfang Hospital Professor of Medicine, Southern Medical UniversityFan Fan Hou MD
Chief, Division of Nephrology, Nanfang Hospital
Professor of Medicine, Southern Medical University What is the background for this study? What are the main findings?

Response: Previous trials (HOST and DIVINe) of folic acid therapy in CKD patients were conducted in patients with advanced CKD and treated with super-high dose of vitamin B or with cyanocobalamin that has been shown to be renal toxic. The current study sought to evaluated the efficacy of folic acid therapy without cyanocobalamin on renal outcomes in patients without folic acid fortification and across a spectrum of renal function at baseline from normal to moderate CKD.

We found that treatment with enalapril-folic acid, as compared with enalapril alone, reduced the risk of progression of CKD by 21% and the rate of eGFR decline by 10% in hypertensive patients. More importantly, the presence of CKD at baseline was a significant modifier of the treatment effect (p for interaction = 0.01). Patients with CKD benefited most from the folic acid therapy, with a 56% and 44% reduction in the risk for progression of CKD and the rate of eGFR decline, respectively. In contrast, the renal protective effect in those without CKD was nominal. What should readers take away from your report?

Response: Folic acid therapy may slow down the progression of CKD in patients without folic acid fortification. Given the potential renal protection suggested by this study as well as the safety and the low cost, folic acid therapy should be considered for the clinical management of patients with CKD, particularly in regions without folic acid fortification. What recommendations do you have for future research as a result of this study?

First: Confirmation of our findings in an independent population is badly needed.
Second: Whether our finding can be extrapolated to populations with higher folate levels remained to be examined.
Third: The molecular mechanisms of the potential renal protective effect of folic acid should be investigated. Thank you for your contribution to the community.


Xu X, Qin X, Li Y, et al. Efficacy of Folic Acid Therapy on the Progression of Chronic Kidney Disease: The Renal Substudy of the China Stroke Primary Prevention Trial. JAMA Intern Med. Published online August 22, 2016. doi:10.1001/jamainternmed.2016.4687.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 23, 2016 by Marie Benz MD FAAD