Reducing homocysteine not beneficial in advanced chronic kidney disease
Does reducing homocysteine levels with supplemental folic acid and B vitamins reduce mortality or morbidity in patients with chronic kidney disease?
Supplemental folic acid and B vitamins in patients with chronic kidney disease does not reduce mortality or the incidence of cardiovascular events. (LOE = 1b)
Jamison RL, Hartigan P, Kaufman JS, et al, for the Veterans Affairs Site Investigators. Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease. A randomized controlled trial. JAMA 2007;298(10):1163-1170. [PMID:17848650]
Randomized controlled trial (double-blinded)
Industry + govt
Supplemental folic acid and B vitamins is not beneficial in high-risk cardiovascular patients. Whether this is also true for patients with chronic renal disease is unknown. These investigators identified 2056 adults, 21 years or older, with advanced or end-stage chronic kidney disease and elevated homocysteine levels (>= 15 umol/L). Patients randomly received, in double-blind fashion (concealed allocation assignment), a once-daily capsule containing folic acid (40 mg), pyridoxine (100 mg), and cyanocobalamin (2mg), or an identical placebo. Individuals assessing outcomes remained masked to treatment group assignment. Complete follow-up occurred for more than 96% of patients for a median length of 3.2 years. Analyses were by intention to treat. Although plasma homocysteine levels were significantly lower in the intervention group, treatment had no effect on all-cause mortality or the incidence of any secondary outcomes, including myocardial infarction, stroke, or amputation. The study was 80% powered to detect a 17% relative risk reduction in mortality in the intervention group compared with the placebo group.
Barry, Henry, et al., editors. "Reducing Homocysteine Not Beneficial in Advanced Chronic Kidney Disease." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease.
Reducing homocysteine not beneficial in advanced chronic kidney disease. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease. Accessed December 2, 2023.
Reducing homocysteine not beneficial in advanced chronic kidney disease. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease
Reducing Homocysteine Not Beneficial in Advanced Chronic Kidney Disease [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 December 02]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease.
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TY - ELEC T1 - Reducing homocysteine not beneficial in advanced chronic kidney disease ID - 426794 ED - Barry,Henry, ED - Ebell,Mark H, ED - Shaughnessy,Allen F, ED - Slawson,David C, BT - EE+ POEM Archive UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease PB - John Wiley & Sons DB - Evidence Central DP - Unbound Medicine ER -