Influence of diabetes on homocysteine-lowering therapy in chronic hemodialysis patients.

ABSTRACT

INTRODUCTION: The effect of homocysteine (Hcy)-lowering therapy may be different in hemodialysis (HD) patients with and without diabetes mellitus (DM). METHODS: Stable HD patients with uremia were administered folic acid and vitamin B for 3 months. The impact of treatment was compared in patients with and without DM. RESULTS: A total of 61 patients (31 men and 30 women) aged 56 ± 13 y completed the study. Among these, 44 patients (72%) did not have DM and 17 (28%) had DM. At baseline, total Hcy and high-sensitivity C-reactive protein (hsCRP) levels were similar. After treatment, the levels of total Hcy and hsCRP were significantly decreased in the nondiabetic group (total Hcy level decreased from 33.63 ± 14.13 µmol/l to 18.94 ± 8.46 µmol/l, p<0.001; hsCRP level decreased from 0.58 mg/dl [range, 0.21-1.05 mg/dl] to 0.22 mg/dl [range, 0.11-0.53 mg/dl], p<0.001) but not in the diabetic group (total Hcy level decreased from 34.97 ± 17.12 µmol/l to 29.53 ± 11.36 µmol/l, p=0.057; hsCRP level decreased from 0.80 mg/dl [range, 0.24-1.47 mg/dl] to 0.49 mg/dl [range, 0.45-0.98 mg/dl], p=0.28). Serial monitoring of total Hcy level showed a more sustained effect of therapy on patients without DM. CONCLUSION: Folic acid and vitamin B administration significantly lower total Hcy and hsCRP levels in HD patients without DM but not in those with DM.