| Homocysteine lowering and cognition in CKD: the Veterans Affairs homocysteine study. | |
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MedLine Citation:
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PMID: 19628319 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Individuals with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) have high plasma total homocysteine (tHcy) levels, which may be a risk factor for cognitive impairment. Whether treatment with high-dose B vitamins to decrease high tHcy levels improves cognition in persons with kidney disease is unknown. STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: A substudy of 659 patients (mean age, 67.3 +/- 11.7 years) who participated in a randomized double-blind clinical trial 5 years in duration conducted in 36 US Department of Veterans Affairs medical centers of the effect on all-cause mortality of vitamin-induced lowering of plasma tHcy level. 236 (35.8%) were treated by using dialysis (ESRD) and 423 (64.2%) had a Cockcroft-Gault estimated creatinine clearance of 30 mL/min or less (advanced CKD). All had high tHcy levels (> or =15 micromol/L) at baseline. Cognitive assessments began during the follow-up period of the main trial 3 years after treatment began; participants subsequently were retested 1 year later to assess cognitive change. INTERVENTION: Daily high-dose B vitamin capsule (40 mg of folic acid, 100 mg of vitamin B(6), and 2 mg of vitamin B(12)) or placebo. OUTCOMES: Cognitive function at initial assessment and 1 year later. MEASUREMENTS: Telephone Interview of Cognitive Status-modified, supplemented with attention, working memory, and executive function tests. RESULTS: Initial cognitive function was impaired in approximately 19% of patients regardless of treatment assignment (vitamin or placebo) or kidney disease status (advanced CKD or ESRD). Treatment decreased tHcy levels by 26.7%. Unadjusted and adjusted analyses showed that treatment did not improve initial cognitive outcomes or affect subsequent cognitive status 1 year later. LIMITATIONS: Cognitive assessments began after treatment was initiated; cognitive assessment was limited. CONCLUSION: Treatment with high daily doses of B vitamins, which decreased tHcy levels, did not affect cognitive outcomes in patients with advanced CKD and ESRD. |
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Authors:
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Christopher B Brady; J Michael Gaziano; Roberta A Cxypoliski; Peter D Guarino; James S Kaufman; Stuart R Warren; Pamela Hartigan; David S Goldfarb; Rex L Jamison |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. Date: 2009-07-23 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 54 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-24 Completed Date: 2009-09-14 Revised Date: 2010-09-07 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 440-9 Citation Subset: IM |
Affiliation:
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Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. cbbrady@bu.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00032435 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Cognition / drug effects, physiology Cognition Disorders / blood*, drug therapy*, etiology Double-Blind Method Female Follow-Up Studies Homocysteine / blood* Humans Kidney Failure, Chronic / blood*, complications, drug therapy* Male Middle Aged Risk Factors United States United States Department of Veterans Affairs* Vitamin B Complex / therapeutic use |
| Grant Support | |
ID/Acronym/Agency:
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R21 DK071292/DK/NIDDK NIH HHS; R21 DK071292-01/DK/NIDDK NIH HHS; R21 DK071292-02/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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12001-76-2/Vitamin B Complex; 454-28-4/Homocysteine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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