The nutritional supplementation in the general population contributes to the proper function of physiological and genetic mechanisms. Indeed, vitamins of the B complex are potent cofactors that intercede in metabolic pathways promoting function and energy production. However, vitamin B supplementation in patients with CKD might contribute to DNA methylation, homocysteine reduction, promote endothelial function, and lower CVD risk. 

“Reverse Epidemiology” in CKD

The complexity of CKD’s treatment makes it difficult to determine the effectiveness of dietary approaches to reduce nutritional risk. Indeed, dialysis is a crucial factor that produces mixed results in different nutritional meta-analyses. 

In CKD, the term “reverse epidemiology” refers to the phenomenon that reflects how the CKD patients treated with dialysis respond in the opposite of that of the general population. Some common examples of this reverse epidemiology are the following:

• The hypercholesterolemia presented in CKD patients has a strong association with higher mortality rates in dialysis patients
• In end-stage renal disease patients, a higher BMI is a preventive factor against coronary artery calcifications.
• A low level of serum homocysteine is a predictor of worse clinical outcomes, such as more extended intrahospital stay and higher-all cause mortality.

In fact, this feature of CKD makes it challenging to treat, and apparent homeostasis can be easily disrupted. Additionally, a clinical eye and expertise are needed to maintain a healthy nutritional status in these patients. Nutritional supplementation should be carefully assessed and monitored due to the constant changes in uremic state and the dialysis factor that is constantly contributing to nutrient depletion.

Nutritional supplementation in CKD patients

Maintaining the nutrient balance of CKD patients depends on constant monitoring, assessment, and the supplementation of vitamins and minerals. In the case of CKD, genetic profiling and current literature in the epigenetic landscape ensure that cofactors contribute to epigenetic regulation and homocysteine balance maintenance.

Folate (vitamin B9)

The term folate refers to multiple forms of vitamin B9, such as tetrahydrofolic, methyltetrahydrofolate, methenyltetrahydrofolate, folacin, and pteroylglutamic acid. However, the human body can not produce or synthesize vitamin B9, and the diet should supply it. Folate’s recommended diary allowance (RDA) is 400 mcg of dietary folate equivalents (DFE). Furthermore, vitamin B9 has a crucial role in maintaining SAM levels by producing tetrahydrofolate (THF), a precursor of 5-MTHF. In turn, 5- MTHF promotes methionine synthase activity.

There exists extensive literature that supports the supplementation of folate on patients with CKD. However, some results are mixed, mainly due to the emerging theory that folate improves endothelial dysfunction in CKD patients. Besides this theory, folate is a critical player in the methionine cycle, as its supplementation is associated with lower levels of homocysteine, potentially regulating DNA methylation.

Furthermore, vitamin B6 has a powerful influence over folate in patients with CKD. Indeed, vascular cells lack the cystathionine B- synthase (CBS), a vitamin B6 enzyme. Without this, vascular cells can not eliminate homocysteine through the folate and vitamin B-12 methylation pathway, promoted by MTHFR and MTS. Therefore, the vitamin B complex contributes to the proper endothelial function by promoting enzyme functionality and reducing homocysteine levels.

Cobalamin (vitamin B12)

The primary role of cobalamin is to work as a cofactor for methionine synthase in the one-carbon metabolism pathways, reflecting in the regulation of DNA methylation. In addition, vitamin B12 deficiency is common in patients with CKD, resulting in elevated homocysteine levels. Besides this, cobalamin has multiple functions in different physiological pathways, and due to the complexity of its absorption, its deficiency is not uncommon. 

Nevertheless, clinical studies about the association of vitamin B12 and CKD have found mixed results. Some studies conclude that high vitamin B 12 levels are associated with all-cause mortality in dialysis patients. Evolutionary prevention of vitamin B 12 uptake can explain this phenomenon in uremic patients. Indeed, this mechanism works as a precautionary measure to avoid cobalamin uptake by infectious organisms in peripheral tissues. Therefore, the noticeable higher vitamin B12 level reflects the lack of it in peripheral tissues, and HHcy and higher CVD risk follow this.

The complexity and multifactorial features of CKD make it a complex disease to treat. However, current literature considers the reverse epidemiology factor explains with a clinical eye the effects of vitamin B supplementation. In patients with CKD, it is crucial to monitor micronutrient deficiency closely and supplement with needed. Furthermore, the importance of homocysteine balance and the effects of vitamin B9 and B12 position them as key players in CVD risk prevention and atherosclerosis amelioration.- Ana Paola Rodríguez Arciniega, MS

References:

Cappuccilli, Maria et al. “Vitamin B Supplementation and Nutritional Intake of Methyl Donors in Patients with Chronic Kidney Disease: A Critical Review of the Impact on Epigenetic Machinery.” Nutrients vol. 12,5 1234. 27 Apr. 2020, doi:10.3390/nu12051234

Additional Online Links & Resources (Available 24/7)

 

Online Appointments or Consultations: bit.ly/Book-Online-Appointment

 

Online Physical Injury / Accident Intake Form: bit.ly/Fill-Out-Your-Online-History 

 

Online Functional Medicine Assessment: bit.ly/functionmed

 

Disclaimer

 

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional, licensed physician, and not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and issues that relate to and support, directly or indirectly, our clinical scope of practice.* 

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. Read More.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*

email: coach@elpasofunctionalmedicine.com

phone: 915-850-0900

Licensed in Texas & New Mexico