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首页> 外文期刊>Blood purification >Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients.
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Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients.

机译：降低同型半胱氨酸的维生素B可以减少血液透析患者的心血管事件。

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BACKGROUND: Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovascular events rate. We planned a long-term study to analyze the effects of homocysteine-lowering vitamin B therapy on cardiovascular disease in hemodialysis patients. METHODS: We performed a single center open prospective trial. Patients, just on folate therapy at enrolment, were left out from randomization and maintained folate therapy according to study's protocol (group A). Patients, untreated with folic acid at recruitment, were randomly assigned to other 2 groups: patients submitted to folate supplementation according to study's protocol (group B), and untreated ones (group C). We instructed patients to take 5 mg oral daily folic acid or 5 mg every other day whether serum folate levels were up the normal high limit. We measured homocysteine, folate and vitamin B12 plasma levels at baseline and every 4 months. We chose the appearance of fatal and nonfatal cardiovascular events as end-points. RESULTS: We analyzed data of 114 patients for a median follow-up time of 871 days. Stepwise regression analysis demonstrated that baseline homocysteine levels were related to folate (coefficient: -1.02; F: 64.5), creatinine (coefficient: 0.98; F: 11.3), and C reactive protein (coefficient: -0.64; F: 4.3). Patients ended the study for the following reasons: cardiovascular morbidity (n = 44), death (n = 25), renal transplant (n = 9), moved away (n = 4). Cardiovascular events occurred in 58 of 114 patients (51%), in 26 of 63 (41%) treated patients (both group A and group B) and in 32 of 51 (63%; chi2 = 6.0; p = 0.05) untreated patients (group C). Kaplan-Meier survival analysis showed that cardiovascular events were less frequent in treated patients with low homocysteine levels (chi2 24.1; p < 0.0001). Cox regression analysis showed that cardiovascular events were explained by homocysteine, dialysis vintage, past cardiovascular accidents, and age. We noticed not only lower homocysteine levels, but also higher protein catabolic rate values in events-free patients as compared with patients with nonfatal cardiovascular events. After having divided patients into 4 subgroups according to high and low, split at median, Hcy and protein catabolic rate values, we observed in Kaplan-Meier survival curves for cardiovascular events by these subgroups that patients with low Hcy and high protein catabolic rate values showed a significant lower hazard rate than patients with high Hcy and low protein catabolic rate levels (chi2 = 21.7; p < 0.0001). CONCLUSIONS: This trial shows for the first time that homocysteine-lowering folate therapy decreases cardiovascular events in dialysis patients. It is necessary to perform large prospective studies to confirm our results.
机译：背景：透析患者的心血管事件发生率高于肾功能正常的患者。高同型半胱氨酸血症是心血管疾病的危险因素，经常在透析患者中​​被发现。补充维生素B可以降低高同型半胱氨酸血症，但是否降低心血管事件发生率尚不清楚。我们计划进行一项长期研究，以分析降低同型半胱氨酸的维生素B治疗对血液透析患者的心血管疾病的影响。方法：我们进行了单中心开放性前瞻性试验。入组时仅接受叶酸治疗的患者被排除在随机分组之外，并根据研究方案维持叶酸治疗（A组）。募集时未接受叶酸治疗的患者被随机分为其他两组：根据研究方案接受叶酸补充治疗的患者（B组）和未经治疗的患者（C组）。我们指示患者血清叶酸水平是否超出正常上限，每天口服5 mg叶酸或隔天服用5 mg。我们在基线和每4个月测量一次同型半胱氨酸，叶酸和维生素B12的血浆水平。我们选择致命和非致命心血管事件的出现作为终点。结果：我们分析了114例患者的数据，中位随访时间为871天。逐步回归分析表明，基线高半胱氨酸水平与叶酸（系数：-1.02; F：64.5），肌酐（系数：0.98; F：11.3）和C反应蛋白（系数：-0.64; F：4.3）有关。患者由于以下原因而终止研究：心血管疾病的发病率（n = 44），死亡（n = 25），肾移植（n = 9），移居（n = 4）。心血管事件发生在114名患者中的58名（51％），63名患者中的26名（41％）（A组和B组）和51名患者中的32名（63％; chi2 = 6.0; p = 0.05） （C组）。 Kaplan-Meier生存分析表明，低同型半胱氨酸水平的治疗患者的心血管事件发生频率较低（χ224.1; p <0.0001）。 Cox回归分析显示，高半胱氨酸，透析时间，过去的心血管意外和年龄是造成心血管事件的原因。与非致命性心血管事件患者相比，无事件患者不仅注意到同型半胱氨酸水平降低，而且蛋白分解代谢速率值也更高。根据高和低将患者分为4个亚组后，按中值，Hcy和蛋白质分解代谢率值进行划分，我们在这些心血管疾病的亚组中观察了Kaplan-Meier心血管事件的生存曲线，发现低Hcy和高蛋白质分解代谢率的患者表现出与高Hcy和低蛋白分解代谢率水平的患者相比，危险率显着降低（chi2 = 21.7; p <0.0001）。结论：该试验首次表明降低同型半胱氨酸的叶酸疗法可减少透析患者的心血管事件。有必要进行大规模的前瞻性研究以证实我们的结果。

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