Chronic Kidney Disease Patients Do Not Benefit From Lower Homocysteine Levels

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Main Category: Urology / Nephrology
Also Included In: Cardiovascular / Cardiology;  Blood / Hematology
Article Date: 11 Sep 2007 - 11:00 PDT

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A patient with chronic kidney disease (end-stage) who is treated with high doses of B vitamins and folic acid to reduce homocysteine levels does not experience survival improvements or a lowering of vascular events risk, according to an article published in the Journal of the American Medical Association (JAMA), September 12 issue.

According to several studies, high plasma levels of homocysteine are linked to vascular disease, say the authors. Patients with ESRD (end-stage renal disease) or chronic kidney disease commonly suffer from vascular disease. The annual death rate for ESRD patients have been put as high as 20%. A way to lower homocysteine levels in these patients is to give them high doses of B vitamins and folic acid.

Rex L. Jamison, M.D., Veterans Affairs (VA) Palo Alto Health Care Systems and Stanford University School of Medicine, Stanford, Calif., and team wanted to find out whether high dose B vitamins and folic acid would lower the death rate and cardiovascular events among ESRD and ACKD (advanced chronic kidney disease) patients.

This randomized-controlled trial started in 2001 and ended in 2006. 36 VA centers were involved - including 1,305 ACKD and 751 ESRD patients. They all had high homocysteine levels. They were randomly selected to receive a daily capsule containing vitamin B6 and B12 plus folic acid, or a placebo.

Within three months those taking the vitamin capsules had 26% lower homocysteine levels, compared to 1.7% in the placebo group. When they compared the number of deaths within the two groups they saw no significant difference. Other outcomes, such as the incidence of heart attack, stroke or amputation also remained unchanged.

The authors wrote "What might account for the failure of the treatment in our study? Possibly the underlying burden of disease was too great for a measurable benefit from lowering homocysteine. Our findings do not support the administration of folic acid and B vitamin supplements to prevent vascular injury or improve survival in patients with ACKD or ESRD."

JAMA

Written by: Christian Nordqvist
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