Institute of Biomedicine, Anhui Medical University, Hefei, China.
Clin Nutr. 2013 Oct;32(5):722-7. doi: 10.1016/j.clnu.2012.12.009. Epub 2012 Dec 28.
BACKGROUND & AIMS: The efficacy of homocysteine-lowering therapy with folic acid to lower homocysteine levels in an effort to reduce cardiovascular disease (CVD) risk in patients with kidney disease remains inconclusive. We conducted a meta-analysis of relevant randomized trials to further examine this issue.
This meta-analysis included 8234 patients with kidney disease from nine qualified randomized trials using folic acid therapy, and with CVD reported as one of the endpoints. Relative risk (RR) was used to measure the effect of folic acid supplementation on risk of CVD using a random effects model.
When pooling the nine randomized trials, folic acid therapy reduced the risk of CVD by 10%（RR = 0.90; 95% CI:0.81-1.00, P = 0.046). A greater beneficial effect was observed among those trials without a history of grain fortification with folic acid (0.82; 0.70-0.96, P = 0.01), with lower percent baseline diabetes (<30% (median), 0.80; 0.65-0.99, P = 0.04), and in patients with end-stage renal disease (ESRD) or advanced chronic kidney disease (ACKD) (0.85; 0.77-0.94, P = 0.002). Furthermore, a meta-regression analysis suggested a positive dose-response relationship between percent baseline diabetes and log-RR for CVD risk associated with folic acid supplementation (P = 0.007). Most importantly, even the inclusion of three subgroup results did not substantially affect the results (n = 11032, RR: 0.93; 95% CI:0.87-0.99, P = 0.03).
Our meta-analysis indicates that folic acid supplementation may be effective for CVD prevention in patients with kidney disease, particularly in trials among patients without a history of grain fortification with folic acid, with lower percent baseline diabetes, and in patients with ESRD or ACKD.
用叶酸降低同型半胱氨酸水平以降低患肾病患者心血管疾病（CVD）风险的疗效仍不确定。我们进行了一项荟萃分析，以进一步研究这个问题。
本荟萃分析纳入了 9 项合格的随机试验中的 8234 例患有肾病且 CVD 作为终点之一的患者，使用叶酸治疗。使用随机效应模型，相对风险（RR）用于衡量叶酸补充对 CVD 风险的影响。
汇总 9 项随机试验时，叶酸治疗使 CVD 风险降低了 10%（RR=0.90；95%CI：0.81-1.00，P=0.046）。在没有叶酸强化谷物历史的试验中，观察到更大的有益效果（0.82；0.70-0.96，P=0.01），基线糖尿病百分比较低（<30%（中位数），0.80；0.65-0.99，P=0.04），以及终末期肾病（ESRD）或晚期慢性肾病（ACKD）患者（0.85；0.77-0.94，P=0.002）。此外，Meta 回归分析表明，叶酸补充与 CVD 风险相关的糖尿病基线百分比与 log-RR 之间存在正剂量反应关系（P=0.007）。最重要的是，即使纳入 3 项亚组结果，也不会实质性影响结果（n=11032，RR：0.93；95%CI：0.87-0.99，P=0.03）。
我们的荟萃分析表明，叶酸补充可能对肾病患者的 CVD 预防有效，特别是在没有叶酸强化谷物历史、基线糖尿病百分比较低以及 ESRD 或 ACKD 患者的试验中。
