Reducing homocysteine not beneficial in advanced chronic kidney disease
Clinical Question
Does reducing homocysteine levels with supplemental folic acid and B vitamins reduce mortality or morbidity in patients with chronic kidney disease?
Bottom Line
Supplemental folic acid and B vitamins in patients with chronic kidney disease does not reduce mortality or the incidence of cardiovascular events. (LOE = 1b)
Reference
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]
Study Design
Randomized controlled trial (double-blinded)
Funding
Industry + govt
Allocation
Concealed
Setting
Outpatient (any)
Synopsis
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.
Citation
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 October 7, 2024.
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 2024 October 07]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426794/all/Reducing_homocysteine_not_beneficial_in_advanced_chronic_kidney_disease.
* Article titles in AMA citation format should be in sentence-case
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 -