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Folic acid therapy and cardiovascular disease in ESRD or advanced chronic kidney disease: a meta-analysis
Xianhui Qin1, Yong Huo, Craig B Langman
1Institute of Biomedicine, Anhui Medical University, Hefei, China.
Insights
Folic acid therapy significantly reduces cardiovascular disease risk by 15% in patients with advanced chronic kidney disease. This benefit is enhanced with longer treatment durations and greater homocysteine level reductions.
Area of Science:
- Nephrology
- Cardiology
- Nutritional Science
Background:
- Cardiovascular disease (CVD) is a major concern for patients with end-stage renal disease (ESRD) or advanced chronic kidney disease (ACKD).
- The role of homocysteine (Hcy) lowering via folic acid therapy in mitigating CVD risk in this population remains debated.
Purpose of the Study:
- To conduct a meta-analysis of randomized trials to evaluate the efficacy of folic acid therapy in reducing CVD risk in ESRD/ACKD patients.
- To identify factors influencing the effectiveness of folic acid therapy in this patient group.
Main Methods:
- Meta-analysis of seven randomized trials involving 3886 patients with ESRD/ACKD.
- Included trials reported cardiovascular events as an endpoint.
Main Results:
- Folic acid therapy demonstrated a 15% reduction in CVD risk (RR, 0.85; 95% CI, 0.76 to 0.96).
- Greater benefits were observed with treatment durations exceeding 24 months, homocysteine level reductions over 20%, and in trials with no or partial folic acid fortification.
- A significant benefit was noted when homocysteine levels decreased by over 20%, irrespective of folic acid fortification.
Conclusions:
- Folic acid therapy is effective in reducing CVD risk by 15% in patients with ESRD/ACKD.
- The therapeutic benefit is more pronounced in patients with no or partial folic acid fortification and those achieving a >20% reduction in homocysteine levels.
Background And Objectives:
The efficacy of folic acid therapy to lower homocysteine (Hcy) levels in an effort to reduce cardiovascular disease (CVD) risk in patients with ESRD or advanced chronic kidney disease (ACKD; creatinine clearance, <30 ml/min) remains inconclusive. We conducted a meta-analysis of relevant randomized trials to further examine this issue.
Design, Setting, Participants, & Measurements:
This meta-analysis included 3886 patients with ESRD/ACKD from seven qualified randomized trials using folic acid therapy and with CVD reported as one of the end points.
Results:
When pooling the seven trials, folic acid therapy reduced the risk of CVD by 15% (RR, 0.85; 95% CI, 0.76 to 0.96; P = 0.009). A greater beneficial effect was observed among those trials with a treatment duration >24 months (RR, 0.84; 95% CI, 0.72 to 0.98; P = 0.02), a decrease in Hcy level >20% (RR, 0.83; 95% CI, 0.73 to 0.95; P = 0.007), and no or partial folic acid fortification (RR, 0.80; 95% CI, 0.65 to 0.99; P = 0.04). The beneficial effect also was seen when Hcy levels decreased >20%, even in the presence of folic acid fortification (RR, 0.85; 95% CI, 0.73 to 0.99; P = 0.04). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant.
Conclusions:
Folic acid therapy can reduce CVD risk in patients with ESRD/ACKD by 15%. A greater beneficial effect was observed among those trials with no or partial folic acid fortification or a decrease in Hcy level >20% regardless of folic acid fortification.
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