Abstract | BACKGROUND: STUDY DESIGN: Meta-analysis of retrospective (11 studies including 1,506 individuals), prospective observational studies (12 studies including 1,975 individuals), and intervention trials (5 studies including 1,642 dialysis patients). Analyses were carried out separately, according to the study design. SETTING & POPULATION: SELECTION CRITERIA FOR STUDIES: INTERVENTION: OUTCOMES: In retrospective studies, cases are patients with cardiovascular diseases. Outcomes for prospective observational and intervention studies are cardiovascular events and total mortality. RESULTS: In retrospective studies, there was no significant overall difference in homocysteine concentrations between cases and controls (weighted mean difference in homocysteine, 2.82 micromol/L; 95% confidence interval [CI], -2.22 to 7.86; P = 0.3). The pooled overall risk estimate for prospective observational studies suggests no association between homocysteine level (5-micromol/L increase) and total mortality (hazard ratio [HR], 1.02; 95% CI, 0.93 to 1.12; P = 0.7), but there was an association with cardiovascular events (HR, 1.09; 95% CI, 1.03 to 1.14; P = 0.001). In subgroup analysis of patients not receiving vitamins, an increase in homocysteine level was associated with increased mortality (HR, 1.07; 95% CI, 1.02 to 1.13; P = 0.01). For intervention trials with B vitamins, there was a significant risk reduction for cardiovascular disease (relative risk, 0.73; 95% CI, 0.56 to 0.94; P = 0.02), but no risk reduction for total mortality or the composite end point including total mortality (relative risk, 1.01; 95% CI, 0.88 to 1.15; P = 0.9). LIMITATIONS: Many studies are small, which may lead to the observed heterogeneity. Some intervention trials are neither placebo controlled nor randomized. Separate analyses for specific end points and patients treated by means of hemodialysis or peritoneal dialysis were not possible. CONCLUSION:
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Authors | Judith Heinz, Siegfried Kropf, Claus Luley, Jutta Dierkes |
Journal | American journal of kidney diseases : the official journal of the National Kidney Foundation
(Am J Kidney Dis)
Vol. 54
Issue 3
Pg. 478-89
(Sep 2009)
ISSN: 1523-6838 [Electronic] United States |
PMID | 19359080
(Publication Type: Comparative Study, Journal Article, Meta-Analysis)
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Chemical References |
- Homocysteine
- Folic Acid
- Vitamin B 12
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Topics |
- Cardiovascular Diseases
(blood, etiology, therapy)
- Clinical Trials as Topic
(methods)
- Folic Acid
(therapeutic use)
- Homocysteine
(blood)
- Humans
- Kidney Failure, Chronic
(blood, complications, therapy)
- Prospective Studies
- Renal Dialysis
(adverse effects)
- Retrospective Studies
- Risk Factors
- Vitamin B 12
(therapeutic use)
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