Is Folic Acid Safe for Patients with Kidney Disease? A Doctor's Insight

Concerns about folic acid intake in kidney disease?

Hello Doctor, I am a physician with renal tubular dysfunction, and my attending physician mentioned that I have a condition called Fanconi syndrome.
Recently, I experienced headaches and discomfort in my legs, so I consulted a neurologist who found that my folate level was only 2.5.
They prescribed Folic Acid 5 mg, to be taken once daily.
Currently, my kidney function is calculated to be stage 3, with a glomerular filtration rate (GFR) of 50 and serum creatinine approximately 1.73.
I would like to ask if it is safe to take this folic acid medication.
Will it increase the burden on my kidneys? Is the dosage too high? Will it have any impact on my kidney function? I have heard that folic acid is a type of vitamin, and it seems that those with poor kidney function need to be cautious about taking such supplements, so I am reaching out for advice.

Xiao You, 20~29 year old female. Ask Date: 2022/05/26

Dr. Wu Jiyu reply Internal Medicine

Based on your inquiry, if your folate level is only 2.5, it is indeed insufficient.
Therefore, supplementing with 5 mg of folic acid once a day is just adequate and will not harm the kidneys or increase their burden.
Thank you for your question.
The Nephrology Department at Changhua Hospital cares about you.

Reply Date: 2022/05/26

More Info

Folic acid, also known as vitamin B9, plays a crucial role in various bodily functions, including DNA synthesis, repair, and methylation, as well as cell division. For patients with kidney disease, particularly those with chronic kidney disease (CKD) like yourself, the safety and appropriateness of folic acid supplementation can be a concern, especially given your diagnosis of Fanconi syndrome.

In general, folic acid is considered safe for patients with kidney disease. The kidneys are responsible for filtering waste products from the blood, and while they do play a role in the metabolism of certain vitamins, folic acid is water-soluble and excess amounts are typically excreted through urine. This means that, in most cases, folic acid does not accumulate to toxic levels in the body, even in patients with compromised kidney function.

Your current dosage of 5 mg per day is a common therapeutic dose for individuals with low folate levels. The recommended dietary allowance (RDA) for folate varies by age and gender, but for adults, it is generally around 400 micrograms (0.4 mg) per day. In cases of deficiency, higher doses may be prescribed, and 5 mg is often used to correct deficiencies quickly. Given your low folate level of 2.5, this dosage seems appropriate to help restore your folate levels.

However, it is essential to monitor your kidney function regularly while on any medication, including folic acid. Your estimated glomerular filtration rate (eGFR) of 50 indicates that you are in stage 3 of chronic kidney disease, which means your kidney function is moderately impaired. While folic acid is generally safe, it is still important to consider the overall management of your kidney health.
In patients with CKD, especially those with Fanconi syndrome, the focus should be on managing the underlying condition and preventing further kidney damage. This includes monitoring electrolyte levels, managing blood pressure, and ensuring a balanced diet that is appropriate for kidney health. It is also crucial to avoid medications and supplements that may further burden the kidneys unless prescribed by a healthcare professional.

In conclusion, taking folic acid at the prescribed dose of 5 mg per day is generally safe for you, considering your current kidney function and folate levels. However, it is always best to discuss any concerns with your nephrologist or healthcare provider, who can provide personalized advice based on your overall health status and kidney function. Regular follow-ups and blood tests will help ensure that your kidney function remains stable while you address your folate deficiency.

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