vitamin b12 supplementation in end stage renal diseases: a sys-tematic review

background :hyperhomocysteinemia is a risk factor for cardiovascular disease particularly in patients with end stage renal disease (esrd). vitamin b12 supplementation on its own still remains as a controversial issue for clinicians in decreasing the level of homcysteine in this group of patients.   methods : using all randomized controlled trials (rcts), clinical trials and pre-post-trial studies found during january 1999 to march 2014, we conducted a systematic review which assessed the effects of vitamin b12 in decreasing homocysteine levels in patients with esrd.   results : the findings of this study revealed that, overall, the greatest effect of b12 supplementation on decreasing homocysteine levels in patients with esrds occurred when it was combined with folate supplementation. it was also demonstrated that injection treatments might be more beneficial than oral intake treatments.   conclusion : more rigorous studies are needed to draw a firm conclusion about b12 therapy and the level of homocyteine in patients with esrd.