Efficacy and safety of two vitamin supplement regimens on hyperhomocysteinemia in maintenance hemodialysis (mhd) patients

Eficacia y seguridad de dos pautasde suplementos vitamínicos sobre los nivelesde homocisteína en pacientes en hemodiálisis. Ensayo clínico prospectivo y randomizado

The study authors: J. E. Sánchez Álvarez, L. Pérez Tamajón, D. Hernández, A. Álvarez González, P. Delgado, V. Lorenzo.

The results of research on "Efficacy and safety of two vitamin supplement regimens on hyperhomocysteinemia in maintenance hemodialysis (mhd) patients" conducted by J. E. Sánchez Álvarez, L. Pérez Tamajón, D. Hernández, A. Álvarez González, P. Delgado, V. Lorenzo (Sánchez Álvarez JE, Pérez Tamajón L, Hernández D, Álvarez González A, Delgado P, Lorenzo V. Eficacia y seguridad de dos pautas de suplementos vitamínicos sobre los niveles de homocisteína en pacientes en hemodiálisis. Ensayo clínico prospectivo y randomizado. Nefrologia 2005;25:288-96.).

Efficacy and safety of two vitamin supplement regimens on hyperhomocysteinemia in maintenance hemodialysis (mhd) patients

High levels of homocysteine (tHcy) are frecuent in MHD patients, and recognized as a risk factor for cardiovascular events.

Vitamin supplements have been shown to lower serum Hcys, although optimal dose and efficacy is not well defined. Moreover, methylenetetrahydrofolate reductase (MTHFR) gene polymorphism can modulate its prevalence and response to treatment.

Objective: To evaluate efficacy and safety of two vitamin supplement regimens on Hcys serum levels over a 12 month period.

Methods: We conducted a prospective, randomised, double-blind trial in 60 stable MHD patients (68 ± 13 years, 48% male, 50% diabetics). Patients were randomly assigned to one of two treatment regimens: 1) daily renal multivitamin containing folate (FA), vitamin B6 and B12 (5 mg, 10 mg and 0.4 mg respectively) (N = 27); and 2) supraphysiological daily doses (15 mg, 100 mg and 1 mg) (N = 33). These regimens were continued throughout the study period. Hcys levels were compared with a control group from the general population (N = 276) matched for age and gender. Measurements: demographic and clinical data, serum levels of Hcys, FA, B6, B12 at baseline and after 1, 3, 6 and 12 months of treatment; MTHFR gene polymorphism (PCRRT).

Results: At baseline, global prevalence of hyperhomocysteinemia (tHcy 15 µmol/L) was 100% in patients and 22% en controls. Hcys levels were significantly higher in patients versus controls (32.4 ± 8.9 vs 12.9 ± 6.8; P < 0,0001). Both regimens were equally effective in reducing Hcys levels. As a whole, Hcys levels were reduced by 23.6% (P < 0.001) after one month of treatment. The highest reduction was observed at the sixth month (28.3%, 32.4 ± 8.9 vs 22.7 ± 6.4, P < 0.001) and remained stable thereafter. However, only 12% of patients normalised their plasma levels after 12 months of therapy. The effect of treatment was not influenced by age, gender, diabetes, body weight or time on MHD. Reduction rate of tHcy levels was related to baseline tHcy level (r = 0.500, P < 0.001) and baseline FA levels (r = -0.332, P = 0.009). The MTHFR polimorfism did not significantly modified the effect of the treatment. No side effects were associated with either regimen.

Conclusions: Hyperhomocysteinemia is common in patients with conventional HD schedules and this is not related to vitamin deficiencies. Vitamin supplements significantly reduce Hcys levels in a sustained but suboptimal way. Supraphysiological doses did not improve the results. Further studies are requiered to demonstrate that this effect is associated with an improval in morbidity and mortality.


The complete study "Efficacy and safety of two vitamin supplement regimens on hyperhomocysteinemia in maintenance hemodialysis (mhd) patients" (J. E. Sánchez Álvarez, L. Pérez Tamajón, D. Hernández, A. Álvarez González, P. Delgado, V. Lorenzo) in pdf file format:



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http://www.revistanefrologia.com/es-publicacion-nefrolo-articulo-eficacia-seguridad-dos-pautasde-suplementos-vitaminicos-sobre-los-nivelesde-homocisteina-X021169950501830X

Sánchez Álvarez JE, Pérez Tamajón L, Hernández D, Álvarez González A, Delgado P, Lorenzo V. Eficacia y seguridad de dos pautas de suplementos vitamínicos sobre los niveles de homocisteína en pacientes en hemodiálisis. Ensayo clínico prospectivo y randomizado. Nefrologia 2005;25:288-96.


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The article "Efficacy and safety of two vitamin supplement regimens on hyperhomocysteinemia in maintenance hemodialysis (mhd) patients" in other languages
 
Eficacia y seguridad de dos pautasde suplementos vitamínicos sobre los nivelesde homocisteína en pacientes en hemodiálisis. Ensayo clínico prospectivo y randomizado (J. E. Sánchez Álvarez, L. Pérez Tamajón, D. Hernández, A. Álvarez González, P. Delgado, V. Lorenzo) Español:
Eficacia y seguridad de dos pautasde suplementos vitamínicos sobre los nivelesde homocisteína en pacientes en hemodiálisis. Ensayo clínico prospectivo y randomizado