SynthesisBMJ (Clinical research ed.)2012
The effect of folic acid based homocysteine lowering on cardiovascular events in people with kidney disease: systematic review and meta-analysis.
Synthesis in BMJ (Clinical research ed.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 6 syntheses or guidelines pooled it, 108 citations in OpenAlex.
- Efficacy and safety of folic acid on homocysteine and cardiovascular surrogate biomarkers in hyperhomocysteinemia: a systematic review and meta-analysis of RCTs.BMC nutrition · 2026Pooled it
- Pooled it
- Homocysteine-lowering interventions for preventing cardiovascular events.The Cochrane database of systematic reviews · 2017Pooled it
- Interventions for lowering plasma homocysteine levels in dialysis patients.The Cochrane database of systematic reviews · 2016Pooled it
- Interventions for lowering plasma homocysteine levels in kidney transplant recipients.The Cochrane database of systematic reviews · 2015Pooled it
- Pooled it
- Does preoperative homocysteine level influence the kidney functions after coronary artery bypass grafting?BMC cardiovascular disorders · 2026Article
- Multiple Reaction Monitoring (MRM)-Based Targeted Kidney Metabolite Profiling of a Mouse Model of Hyperuricemia.Metabolites · 2026Article
- Sex-Differentiated Threshold Effects of Homocysteine Levels on CKD Risk in Patients with Hypertension and Coronary Artery Disease.Journal of inflammation research · 2026Article
- Article
- Associations of total homocysteine and kidney function with all-cause and cause-specific mortality in hypertensive patients: a mediation and joint analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2024Article
- Hyperhomocysteinaemia Promotes Doxorubicin-Induced Cardiotoxicity in Mice.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Phenome-wide association study of genetically predicted B vitamins and homocysteine biomarkers with multiple health and disease outcomes: analysis of the UK Biobank.The American journal of clinical nutrition · 2023Article
- Pathophysiological concepts and screening of cardiovascular disease in dialysis patients.Frontiers in nephrology · 2023Review
- Minor allele of rs55763075 located in MTHFR is associated with the risk of cognitive impairment after anesthesia via modulating miR-34b.Scientific reports · 2021Article
- Article
- Discrimination of Chronic Kidney Disease and Diabetic Nephropathy and Analysis of Their Related Influencing Factors.Diabetes, metabolic syndrome and obesity : targets and therapy · 2020Article
- Review
- Hyperhomocysteinaemia and vascular injury: advances in mechanisms and drug targets.British journal of pharmacology · 2018Review
- Article
Corrections and comments
- Commented on by
Authors and funding
10 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo systematically review the effect of folic acid based homocysteine lowering on cardiovascular outcomes in people with kidney disease.
designSystematic review and meta-analysis. DATA SOURCES: Medline, Embase, the Cochrane Library, and ClinicalTrials.gov to June 2011. STUDY SELECTION: Randomised trials in people with non-dialysis dependent chronic kidney disease or end stage kidney disease or with a functioning kidney transplant reporting at least 100 patient years of follow-up and assessing the effect of folic acid based homocysteine lowering therapy. No language restrictions were applied. DATA EXTRACTION: Two reviewers independently extracted data on study setting, design, and outcomes using a standardised form. The primary endpoint was cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality, or as defined by study author). Secondary endpoints included the individual composite components, all cause mortality, access thrombosis, requirement for renal replacement therapy, and reported adverse events, including haematological and neurological events. The effect of folic acid based homocysteine lowering on outcomes was assessed with meta-analysis using random effects models.
results11 trials were identified that reported on 4389 people with chronic kidney disease, 2452 with end stage kidney disease, and 4110 with functioning kidney transplants (10,951 participants in total). Folic acid based homocysteine therapy did not prevent cardiovascular events (relative risk 0.97, 95% confidence interval 0.92 to 1.03, P = 0.326) or any of the secondary outcomes. There was no evidence of heterogeneity in subgroup analyses, including those of kidney disease category, background fortification, rates of pre-existing disease, or baseline homocysteine level. The definitions of chronic kidney disease varied widely between the studies. Non-cardiovascular events could not be analysed as few studies reported these outcomes.
conclusionsFolic acid based homocysteine lowering does not reduce cardiovascular events in people with kidney disease. Folic acid based regimens should not be used for the prevention of cardiovascular events in people with kidney disease.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.