Does B-vitamin therapy help with diabetic nephropathy?

January 01, 0001

Does B-vitamin therapy help with diabetic nephropathy?

Elevated homocysteine levels are frequently found in patients with diabetic nephropathy, and have also been linked to cardiovascular risk. B-vitamin therapy has been shown to lower homocysteine levels. These Canadian researchers sought to determine whether B-vitamin therapy can slow progression of diabetic nephropathy and prevent vascular complications. They performed a multicenter, randomized, double-blind, placebo- controlled trial (Diabetic Intervention with Vitamins to Improve Nephropathy [DIVINe

The authors report: "The mean follow-up during the trial was 31.9 months. At 36 months, radionuclide GFR decreased by a mean of 16.5 mL/min/1.73 m2 in the B-vitamin group compared with 10.7 mL/min/1.73 m2 in the placebo group (mean difference, -5.8). There was no difference in requirement of dialysis (HR, 1.1). The composite outcome occurred more often in the B-vitamin group (HR, 2.0). Plasma total homocysteine decreased by a mean of 2.2 µmol/L at 36 months in the B-vitamin group compared with a mean increase of 2.6 µmol/L in the placebo group (mean difference, -4.8, in favor of B vitamins)."

The authors concluded: "Among patients with diabetic nephropathy, high doses of B vitamins compared with placebo resulted in a greater decrease in GFR and an increase in vascular events."

This randomized controlled trial found, while B-vitamin therapy did lower homocysteine levels in patients with diabetic nephropathy, it worsened nephropathy and increased cardiovascular risk.

For the full abstract, click here.

JAMA 303(16):1603-1609, 28 April 2010 © 2010 the American Medical Association
Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy: A Randomized Controlled Trial, , House et al.. Andrew A. House, Misha Eliasziw, Daniel C. Cattran, et al.

Category: U. Urinary. Keywords: diabetes, diabetic nephropathy, b vitamins, homocysteine, DIVINe trial, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 28 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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