Vitamin B Supplementation and Homocysteine Reduction in Nigerian Children with Nephrotic Syndrome: A Randomized Controlled Trial

Nephrotic syndrome (NS) in children is associated with hyperhomocysteinemia, increasing the risk of cardiovascular disease. The deficiency of vitamins B6, B12, and folate contribute to elevated homocysteine levels, yet limited interventional studies have evaluated the effects of vitamin supplementation in pediatric NS patients. This study investigated the effect of folic acid, vitamin B6, and vitamin B12 supplementation on plasma homocysteine levels in Nigerian children with NS. A single-blind, randomized controlled trial was conducted at the University College Hospital, Ibadan, Nigeria. Forty-eight children with NS and plasma homocysteine >10 μmol/L were randomly assigned to receive either daily supplementation (5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12) or placebo for six months. The primary outcome was homocysteine reduction, while secondary outcomes included changes in vitamin levels, renal function, and lipid profiles. At baseline, demographic and biochemical parameters were similar between groups. After six months, the intervention group showed a significant reduction in homocysteine levels (12.8 ± 1.4 μmol/L to 6.9 ± 2.1 μmol/L, p < 0.001), while the control group had minimal change (13.3 ± 1.8 μmol/L to 12.9 ± 1.9 μmol/L, p = 1.000). The intervention group also had greater reductions than the control group in total cholesterol (-13.2 mg/dL vs. -4.9 mg/dL, p < 0.001) and LDL cholesterol (-9.8 mg/dL vs. -3.6 mg/dL, p < 0.001). Renal function parameters improved similarly in both groups. No serious adverse effects were reported, and adherence was 91.7%. Vitamin B supplementation significantly reduced plasma homocysteine and improved lipid profiles in children with NS. These findings suggest potential cardiovascular benefits, warranting further research with larger cohorts and longer follow-up.