What Is the Meaning of Homocysteine in Patients on Dialysis?

Almeida, Carla Cristina Silva de; Guerra, Daiane Cristina; Vannucchi, Maria Terezinha Infantosi; Geleilete, Tufik J.; Vannucchi, Hélio; Chiarello, Paula Garcia

doi:10.1053/j.jrn.2010.12.005

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…These observations of the risks associated with various homocysteine levels led in part to the generation of the “reverse epidemiology hypothesis,” which asserts altered risk factor patterns may be confounded by the poor nutrition and inflammatory state common in patients requiring dialysis such that the association of homocysteine and outcomes is driven by nutritional state 4647 Another explanation supported by some45 48 49 but not all5 50 51 analyses, is that homocysteine is simply a marker of kidney function. Regardless of the nature of the association reported by observational studies, it is now clear that interventions to lower homocysteine levels in people with kidney disease do not lead to a reduction in cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis

Jardine

Kang

Zoungas

et al. 2012

BMJ

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Objective To systematically review the effect of folic acid based homocysteine lowering on cardiovascular outcomes in people with kidney disease.Design Systematic review and meta-analysis.Data sources Medline, Embase, the Cochrane Library, and ClinicalTrials.gov to June 2011.Study selection Randomised trials in people with non-dialysis dependent chronic kidney disease or end stage kidney disease or with a functioning kidney transplant reporting at least 100 patient years of follow-up and assessing the effect of folic acid based homocysteine lowering therapy. No language restrictions were applied.Data extraction Two reviewers independently extracted data on study setting, design, and outcomes using a standardised form. The primary endpoint was cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality, or as defined by study author). Secondary endpoints included the individual composite components, all cause mortality, access thrombosis, requirement for renal replacement therapy, and reported adverse events, including haematological and neurological events. The effect of folic acid based homocysteine lowering on outcomes was assessed with meta-analysis using random effects models.Results 11 trials were identified that reported on 4389 people with chronic kidney disease, 2452 with end stage kidney disease, and 4110 with functioning kidney transplants (10 951 participants in total). Folic acid based homocysteine therapy did not prevent cardiovascular events (relative risk 0.97, 95% confidence interval 0.92 to 1.03, P=0.326) or any of the secondary outcomes. There was no evidence of heterogeneity in subgroup analyses, including those of kidney disease category, background fortification, rates of pre-existing disease, or baseline homocysteine level. The definitions of chronic kidney disease varied widely between the studies. Non-cardiovascular events could not be analysed as few studies reported these outcomes.Conclusions Folic acid based homocysteine lowering does not reduce cardiovascular events in people with kidney disease. Folic acid based regimens should not be used for the prevention of cardiovascular events in people with kidney disease.

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Section: Discussionmentioning

confidence: 99%

The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis

Jardine

Kang

Zoungas

et al. 2012

BMJ

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The Relationship Between Homocysteine Level and Vitamins B12, B9 and B6 Status in Patients With Chronic Kidney Disease

et al. 2019

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1,, 1 2 ABSTRACT Introduction: According to present knowledge, hyperhomocysteinemia is one of the risk factors of cardio-vascular pathology. Patients with chronic kidney disease are known to develop hyperhomocysteinemia more often than those in general population. Іmportant cause of hyperhomocysteinemia is the deficiency of vitamins В6, В9 and В12 that are involved in homocysteine metabolism. Vitamins deficiency, we believe, can be one of the causes of hyperhomocysteinemia in the patients with chronic renal failure. The aim: To analyze the plasma homocysteine level in patients with chronic kidney disease and its assosiation with the levels of vitamins B6, B9, B12 in Ukraine. Materials and methods: The study involved 148 persons with different stagesis of chronic kidney disease who underwent immunoenzyme determination of total plasma homocysteine, B9, cobalamin and vitamin В6 status. Results: It was found that in ukrainian patient population with chronic kidney disease 58.7% of patients have hyperhomocysteinemia. Homocysteine level was shown to increase with the increase of chronic kidney disease stage. Supply of vitamins В6, В9 та В12 in the patients with chronic kidney disease was lower than in apparently healthy persons, but there was significant decrease of folic acid level proportionally to the increase of chronic kidney disease stage. There was close relationship between homocysteine level and folic acid status in the patients with chronic kidney disease, but it appeared to be independent on cobalamin and pyridoxin status. Conclusions: The obtained data are promising for finding effective means of correction of hyperhomocysteinemia in patients with chronic kidney disease by normalizing the vitamin status of such patients.

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What Is the Meaning of Homocysteine in Patients on Dialysis?

Cited by 2 publications

References 32 publications

The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis

The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis

The Relationship Between Homocysteine Level and Vitamins B12, B9 and B6 Status in Patients With Chronic Kidney Disease

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