Safety and effectiveness of intravenous vitamin B combination in chronic kidney disease patients with hyperhomocysteinemia

Abstract

Chronic kidney disease (CKD) is a common disease in Indonesia. The prevalence of CKD in Indonesia is increase from 2.0 ‰ in 2013 to 3.8 ‰ in 2018 (Ministry of Health Republic of Indonesia, 2018). The number of new hemodyalisis patients in Indonesia increase consistently from 2013 to 2017 (Indonesian Nephrology Association, 2010) In 2018, the proportion of CKD . patients with hemodyalisis is 19.3 % (Ministry of Health Republic of Indonesia, 2018). CKD leads to poor outcomes and high costs in Indonesia. According to data from national insurance system, CKD is the third leading cause of catastrophic disease in Indonesia (Sarnak et al., 2003). Cardiovascular disease (CVD) and stroke are the most common cause of death in the setting of end-stage renal disease (Collins et al., 2014). Individuals with CKD are more likely to die of CVD than from the progress of the disease itself (McCullough et al., 2011). Hyperhomocysteinemia is present in the majority of CKD patients and among patients undergoing hemodialysis (Danis et al., 2008). The prevalence of hyperhomocysteinemia is over 80% among dialysis patients (Turner et al., 2011). Hyperhomocysteinemia appears to be associated with increased cardiovascular disease risk (Tamadon et al., 2011; McNulty and Scott, 2008). In the general population, hyperhomocysteinemia is commonly associated with deficiencies in a folic acid and vitamin B. Vitamin B and folate supplementation effectively reduce homocysteine levels in the general population (Turner et al., 2012).