Homocysteine, the kidney, and vascular disease

Chronic kidney disease is common and those who have it are at substantially higher risk of cardiovascular disease.1 The association between these two diseases is partly explained by their shared causes (such as diabetes) and by disturbances in known vascular risk factors caused by chronic kidney disease (such as higher blood pressure and altered lipid metabolism).2 However, these risk factors do not seem to fully explain the excess risk, and other risk factors, including homocysteine, have been implicated. The linked meta-analysis by Jardine and colleagues (doi:10.1136/bmj.e3533) examines the relevance for cardiovascular disease risk of lowering blood homocysteine concentrations in people with chronic kidney disease.3 If low cost and effective interventions to reduce homocysteine (such as folic acid supplements) could also reduce risk of cardiovascular disease in these patients then the benefits for public health could be substantial (in addition to explaining the link between these diseases).

The homocysteine hypothesis of coronary heart …