NEW YORK (Reuters Health) - Dimercaptosuccinic acid (DMSA) is not effective in lowering elevated homocysteine levels in hemodialysis patients, according to a report in the October American Journal of Kidney Diseases.
Based on two small pilot studies and on the hypothesis that DMSA could displace and chelate homocysteine from albumin, Dr. Andrew A. House from University of Western Ontario, London, Ontario, Canada and colleagues investigated whether daily administration of DMA could decrease plasma homocysteine levels in 38 vitamin-replete hemodialysis patients.
In both DMSA and placebo groups, the authors report, homocysteine levels remained virtually unchanged after 4 and 8 weeks. Multivariable adjustments for baseline characteristics of the patients did not alter the results.
“We are currently investigating a number of potential agents to lower homocysteine in dialysis, each of which shares the same mechanism of action, that is to displace homocysteine from albumin, to which it is tightly bound and relatively inaccessible to dialysis,” Dr. House told Reuters Health.
“One such agent is N-acetylcysteine, which has been shown to acutely lower homocysteine during dialysis,” Dr. House said. “We believe there are other agents that are more potent in this effect, and are commencing clinical trials to confirm this imminently.”
“Homocysteine remains an unproven risk factor for cardiovascular disease,” he added. “Until such time as we can safely lower homocysteine, and in doing so demonstrate a beneficial outcome through rigorously designed clinical trials, clinicians caring for dialysis patients should remain focused on modification of proven risk factors.”
Source: Am J Kidney Dis 2004;44:689-694. [ Google search on this article ]
MeSH Headings:Acids, Acyclic: Dicarboxylic Acids: Succimer: Health Occupations: Health Services Administration: Outcome and Process Assessment (Health Care): Quality of Health Care: Sulfhydryl Compounds: Drugs, Investigational: Organotechnetium Compounds: Treatment Outcome: Outcome Assessment (Health Care): Health Care Quality, Access, and Evaluation: Health Care Evaluation Mechanisms: Technetium Tc 99m Dimercaptosuccinic Acid: Succinic Acids: Hyperhomocysteinemia: Biological Sciences: Health CareCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
