Role of homocysteine in end-stage renal disease

► Dialysis patients have increased plasma homocysteine (Hcy) and cardiovascular events. ► Hcy-lowering therapy benefits in nondiabetic end-stage renal disease (ESRD) patients. ► Folic acid fortification may weaken the therapeutic effects of Hcy-lowering therapy. ► A simple mathematical model to explain the experimental observations. ► Comorbid conditions may influence the effect of Hcy-lowering therapy in ESRD patients.