Homocysteine Lowering in End-Stage Renal Disease
نویسنده
چکیده
In 1969, McCully reported an association between homocystinuria, a rare metabolic disorder characterized by high blood levels ( 100 mol/L) of the amino acid homocysteine (Hcy), and severe atherosclerosis among postmortem subjects.1 His report is widely recognized as the basis for the “homocysteine hypothesis,” namely, that elevated blood Hcy is a risk factor for cardiovascular disease (CVD). Since then, a wealth of supporting observational epidemiological evidence has accumulated. In a 2002 meta-analysis of 11 prospective cohort studies of individuals without a history of CVD, a 25% (3 mol/L) reduction in Hcy was associated with an 11% lower risk of coronary heart disease events and a 19% lower risk of stroke after adjustment for smoking, blood pressure, total cholesterol, and regression dilution.2 Surprisingly, these findings were not confirmed in randomized controlled trials (RCTs). Two meta-analyses of RCTs that used folic acid and B vitamins to lower blood Hcy found almost no effects on fatal and nonfatal CVD events.3,4 Thus, many have concluded that the relationship between Hcy and CVD events is simply due to confounding in the observational studies. One potentially important confounder is chronic kidney disease. Hcy levels are inversely associated with glomerular filtration rate, which is itself inversely associated with CVD and its related phenotypes (eg, carotid intimal medial thickness).5,6 Therefore, the relationship between Hcy and CVD events among observational studies could have been due in part to unmeasured chronic kidney disease. Nevertheless, the question of whether Hcy is a CVD risk factor persists for several reasons.
منابع مشابه
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 stu...
متن کاملThe effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis
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 kidn...
متن کاملIs folate a promising agent in the prevention and treatment of cardiovascular disease in patients with renal failure?
Management of the conventional cardiovascular risk factors is insufficient to prevent the dramatic increase in atherosclerotic cardiovascular morbidity and mortality in patients with renal failure. Folate recently received attention as a potential alternative treatment option to decrease the excess cardiovascular risk in the uremic population. Folate administration is the principal treatment mo...
متن کاملTherapeutic Potential of Progranulin in Hyperhomocysteinemia-Induced Cardiorenal Dysfunction.
Hyperhomocysteinemia (hHcys) is an important independent risk factor for the development of cardiovascular disease and end-stage renal disease. Although multiple approaches lowering the levels of homocysteine have been used in experimental studies and clinical trials, there is no effective therapy available to fully prevent homocysteine-induced injury. Therefore, identifying key molecules in th...
متن کاملMedical options to fight mortality in end-stage renal disease: a review of the literature.
Many therapeutic strategies for end-stage renal disease (ESRD) patients have failed to exhibit survival improvement in large-scale randomized controlled trials (RCTs). The current review gives an overview on the medical strategies for treatment of ESRD patients that have previously been tested in RCTs with mortality reduction as pre-specified study endpoint. We identified 19 RCTs with the follo...
متن کاملAvoidance of Dialysis in an End-Stage Renal Disease Patient Status-post Off-pump Coronary Artery Bypass Grafting
Certain benefits are clearly associated with the use of off-pump coronary artery bypass grafting (CABG) as compared with the on-pump CABG. The superiority is more evident in patients with multiple co morbidities including renal failure.We reviewed the medical records of a 67-year-old male with a past medical history that was significant for multiple cardiovascular diseases and new-onset end-sta...
متن کامل