Mesna for the treatment of hyperhomocysteinemia in hemodialysis patients.

ABSTRACT

BACKGROUND: Increased plasma total homocysteine (tHcy) is a risk factor for the development of atherosclerosis and thrombosis present in over 90% of patients with end-stage renal disease (ESRD). We hypothesized that 12 mg/kg intravenous mesna administered predialysis would cause a significant decrease in plasma tHcy compared to placebo. METHODS: Patients with ESRD were recruited for 1- and 4-week placebo-controlled, cross-over studies. Intravenous 12 mg/kg mesna or placebo was administered 3 times weekly predialysis. RESULTS: One week of 12 mg/kg intravenous mesna significantly decreased predialysis plasma tHcy by 12.8 +/- 7.8% (placebo 23.4 +/- 8.0 micromol/l vs. mesna 20.5 +/- 7.6 micromol/l, p = 0.0044). Four weeks of treatment yielded no significant decline in predialysis plasma tHcy (placebo 18.3 +/- 8.5 micromol/l vs. mesna 18.7 +/- 6.3 micromol/l, p = 0.41). CONCLUSIONS: Although 12 mg/kg mesna significantly enhances tHcy excretion, prolonged treatment causes no change in plasma tHcy.