FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM
See session information ♦ See EAL review results

Chronic Kidney Disease

CKD: Folate (2018)

Intervention
What is the effect of folate supplementation on mortality in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid supplementation did not affect mortality in dialysis patients, but decreased odds of CKD progression combined with all-cause mortality in patients with CKD Stage 3.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on mortality in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on end stage renal disease in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid supplementation with Enalapril decreased odds of ≥50% decrease in glomerular filtration rate (GFR) or end-stage renal disease (ESRD) (GFR<15 or need for dialysis).
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on end stage renal disease in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Xu X, Qin X, Li Y, Sun D, Wang J, Liang M, Wang B, Huo Y, Hou F. Efficacy of Folic Acid Therapy on the Progression of Chronic Kidney Disease: The Renal Substudy of the China Stroke Primary Prevention Trial. JAMA Internal Medicine 2016; 176:1443-1450
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on cardiovascular disease outcomes in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid supplementation did not affect cardiovascular disease outcomes.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on cardiovascular disease outcomes in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on intima media thickening in adults with CKD 1-5D and post-transplant?
- Conclusion
  The effect of folic acid supplementation on carotid wall thickness were unclear.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on intima media thickening in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on endothelium-dependent flow mediated dilation in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid supplementation did not affect endothelium-dependent flow mediated dilation.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on endothelium-dependent flow mediated dilation in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on homocysteine levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Oral folic acid supplementation using a wide range of dosages (0.8-60 mg oral folic acid per day) decreased homocysteine levels by a mean of 3.24 nmol/L (4.86 to 1.62 lower).
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on homocysteine levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on eGFR in adults with CKD 1-5D and post-transplant?
- Conclusion
  When given with Enalapril, folic acid supplementation decreased renal decline compared to the medication alone.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on eGFR in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Xu X, Qin X, Li Y, Sun D, Wang J, Liang M, Wang B, Huo Y, Hou F. Efficacy of Folic Acid Therapy on the Progression of Chronic Kidney Disease: The Renal Substudy of the China Stroke Primary Prevention Trial. JAMA Internal Medicine 2016; 176:1443-1450
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of folate supplementation on folate levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid supplementation increased serum/plasma and red blood count folate levels in a variety of CKD participants.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of folate supplementation on folate levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on all-cause and cardiovascular-related mortality in adults with CKD 1-5D and post-transplant?
- Conclusion
  There was no effect of supplementation of folic acid with other B-vitamins on risk of all-cause mortality or death from cardiovascular causes.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on all-cause and cardiovascular-related mortality in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on cardiovascular disease events in adults with CKD 1-5D and post-transplant?
- Conclusion
  There was no effect of supplementation with folic acid and other B-vitamins on cardiovascular events.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on cardiovascular disease events in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on kidney failure/dialysis initiation in adults with CKD 1-5D and post-transplant?
- Conclusion
  Supplementation with folic acid with vitamins B6 and B12 did not affect risk of dialysis initiation/kidney failure.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on kidney failure/dialysis initiation in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on blood pressure and intima media thickening in adults with CKD 1-5D and post-transplant?
- Conclusion
  Supplementation with folic acid in combination with other B-vitamins had no effect on intima media thickening or blood pressure in patients on hemodialysis, though evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on blood pressure and intima media thickening in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on total cholesterol in adults with CKD 1-5D and post-transplant?
- Conclusion
  Supplementation with folic acid in combination with other B-vitamins had no effect on total cholesterol levels in patients on hemodialysis, though evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on total cholesterol in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on homocysteine levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Supplementation with folic acid in combination with other B-vitamins decreased participant homocysteine levels.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on homocysteine levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on folate and vitamin B12 levels in adults with CKD 1-5D and post-transplant?
- Conclusion
  Oral folic acid supplementation with other B-vitamins increased folic acid levels in a variety of CKD participants. Oral vitamin B12 supplementation, when given with folic acid and at doses of 1 mg/d or and IV dose of 1 mg per week, increase vitamin B12 levels.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on folate and vitamin B12 levels in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on BMI and body weight in adults with CKD 1-5D and post-transplant?
- Conclusion
  In patients on CKD hemodialysis, 5 mg folic acid with a B-complex vitamin may increase body weight, but there is no evidence of effect on BMI. Evidence is limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on BMI and body weight in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on inflammatory markers in adults with CKD 1-5D and post-transplant?
- Conclusion
  Folic acid (5 mg) with B-complex vitamin for three months may decrease C-reactive protein (CRP), but not IL-6, levels, but evidence is limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on inflammatory markers in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)
What is the effect of supplementation with folate combined with other B vitamins on nutritional status indicators in adults with CKD 1-5D, non-dialysis and transplant?
- Conclusion
  Folic acid (5 mg) with B-complex vitamin for three months may increase albumin levels, but did not affect total nitrogen appearance (TNA), but evidence was limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of supplementation with folate combined with other B vitamins on nutritional status indicators in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Micronutrients: Folate (2018)