Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients
- PMID: 16755160
- DOI: 10.1159/000093680
Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients
Abstract
Background: Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovascular events rate. We planned a long-term study to analyze the effects of homocysteine-lowering vitamin B therapy on cardiovascular disease in hemodialysis patients.
Methods: We performed a single center open prospective trial. Patients, just on folate therapy at enrolment, were left out from randomization and maintained folate therapy according to study's protocol (group A). Patients, untreated with folic acid at recruitment, were randomly assigned to other 2 groups: patients submitted to folate supplementation according to study's protocol (group B), and untreated ones (group C). We instructed patients to take 5 mg oral daily folic acid or 5 mg every other day whether serum folate levels were up the normal high limit. We measured homocysteine, folate and vitamin B12 plasma levels at baseline and every 4 months. We chose the appearance of fatal and nonfatal cardiovascular events as end-points.
Results: We analyzed data of 114 patients for a median follow-up time of 871 days. Stepwise regression analysis demonstrated that baseline homocysteine levels were related to folate (coefficient: -1.02; F: 64.5), creatinine (coefficient: 0.98; F: 11.3), and C reactive protein (coefficient: -0.64; F: 4.3). Patients ended the study for the following reasons: cardiovascular morbidity (n = 44), death (n = 25), renal transplant (n = 9), moved away (n = 4). Cardiovascular events occurred in 58 of 114 patients (51%), in 26 of 63 (41%) treated patients (both group A and group B) and in 32 of 51 (63%; chi2 = 6.0; p = 0.05) untreated patients (group C). Kaplan-Meier survival analysis showed that cardiovascular events were less frequent in treated patients with low homocysteine levels (chi2 24.1; p < 0.0001). Cox regression analysis showed that cardiovascular events were explained by homocysteine, dialysis vintage, past cardiovascular accidents, and age. We noticed not only lower homocysteine levels, but also higher protein catabolic rate values in events-free patients as compared with patients with nonfatal cardiovascular events. After having divided patients into 4 subgroups according to high and low, split at median, Hcy and protein catabolic rate values, we observed in Kaplan-Meier survival curves for cardiovascular events by these subgroups that patients with low Hcy and high protein catabolic rate values showed a significant lower hazard rate than patients with high Hcy and low protein catabolic rate levels (chi2 = 21.7; p < 0.0001).
Conclusions: This trial shows for the first time that homocysteine-lowering folate therapy decreases cardiovascular events in dialysis patients. It is necessary to perform large prospective studies to confirm our results.
Copyright 2006 S. Karger AG, Basel.
Comment in
-
The challenge of the unacceptable high mortality in end-stage kidney disease: is folic acid the answer?Blood Purif. 2006;24(4):377-8. doi: 10.1159/000093679. Blood Purif. 2006. PMID: 16755159 No abstract available.
Similar articles
-
Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients.Med Sci Monit. 2003 Apr;9(4):PI19-24. Med Sci Monit. 2003. PMID: 12709680 Clinical Trial.
-
Efficacy of folate and vitamin B12 in lowering homocysteine concentrations in hemodialysis patients.Saudi J Kidney Dis Transpl. 2009 Sep;20(5):779-88. Saudi J Kidney Dis Transpl. 2009. PMID: 19736473 Clinical Trial.
-
Uremic hyperhomocysteinemia: a randomized trial of folate treatment for the prevention of cardiovascular events.Hemodial Int. 2007 Apr;11(2):210-6. doi: 10.1111/j.1542-4758.2007.00171.x. Hemodial Int. 2007. PMID: 17403173 Clinical Trial.
-
Homocysteine and renal disease.Semin Thromb Hemost. 2000;26(3):313-24. doi: 10.1055/s-2000-8407. Semin Thromb Hemost. 2000. PMID: 11011849 Review.
-
Vitamin supplements and cardiovascular risk: review of the randomized trials of homocysteine-lowering vitamin supplements.Semin Thromb Hemost. 2000;26(3):341-8. doi: 10.1055/s-2000-8101. Semin Thromb Hemost. 2000. PMID: 11011852 Review.
Cited by
-
Plasma cystine/methionine ratio is associated with left ventricular diastolic function in patients with heart disease.Heart Vessels. 2023 Dec;38(12):1422-1430. doi: 10.1007/s00380-023-02302-4. Epub 2023 Aug 24. Heart Vessels. 2023. PMID: 37620665
-
Plasma Homocysteine Levels and Cardiovascular Events in Patients With End-Stage Renal Disease: A Systematic Review.Cureus. 2023 Jun 13;15(6):e40357. doi: 10.7759/cureus.40357. eCollection 2023 Jun. Cureus. 2023. PMID: 37456428 Free PMC article. Review.
-
Homocysteine-Lowering Interventions in Chronic Kidney Disease.J Res Pharm Pract. 2021 Dec 25;10(3):114-124. doi: 10.4103/jrpp.jrpp_75_21. eCollection 2021 Jul-Sep. J Res Pharm Pract. 2021. PMID: 35198504 Free PMC article. Review.
-
Gut Microbiome, Functional Food, Atherosclerosis, and Vascular Calcifications-Is There a Missing Link?Microorganisms. 2021 Sep 9;9(9):1913. doi: 10.3390/microorganisms9091913. Microorganisms. 2021. PMID: 34576810 Free PMC article. Review.
-
The effect of folic acid in patients with cardiovascular disease: A systematic review and meta-analysis.Medicine (Baltimore). 2019 Sep;98(37):e17095. doi: 10.1097/MD.0000000000017095. Medicine (Baltimore). 2019. PMID: 31517834 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous