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Cochrane Database of Systematic Reviews

Interventions for lowering plasma homocysteine levels in dialysis patients

Overview of attention for article published in Cochrane database of systematic reviews, May 2016
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Mentioned by

9 X users
1 Facebook page


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Readers on

222 Mendeley
1 CiteULike
Interventions for lowering plasma homocysteine levels in dialysis patients
Published in
Cochrane database of systematic reviews, May 2016
DOI 10.1002/14651858.cd004683.pub4
Pubmed ID

Sagar U Nigwekar, Amy Kang, Sophia Zoungas, Alan Cass, Martin P Gallagher, Satyarth Kulshrestha, Sankar D Navaneethan, Vlado Perkovic, Giovanni FM Strippoli, Meg J Jardine


People with end-stage kidney disease (ESKD) have high rates of cardiovascular events. Randomised controlled trials (RCTs) of homocysteine-lowering therapies have not shown reductions in cardiovascular event rates in the general population. However, people with kidney disease have higher levels of homocysteine and may have different mechanisms of cardiovascular disease. We performed a systematic review of the effect of homocysteine-lowering therapies in people with ESKD. To evaluate the benefits and harms of established homocysteine lowering therapy (folic acid, vitamin B6, vitamin B12) on all-cause mortality and cardiovascular event rates in patients with ESKD. We searched Cochrane Kidney and Transplant's Specialised Register to 25 January 2016 through contact with the Information Specialist using search terms relevant to this review. Studies conducted in people with ESKD that reported at least 100 patient-years of follow-up and assessed the effect of therapies that are known to have homocysteine-lowering properties were included. Two authors independently extracted data using a standardised form. The primary outcome was cardiovascular mortality. Secondary outcomes included all-cause mortality, incident cardiovascular disease (fatal and nonfatal myocardial infarction and coronary revascularisation), cerebrovascular disease (stroke and cerebrovascular revascularisation), peripheral vascular disease (lower limb amputation), venous thromboembolic disease (deep vein thrombosis and pulmonary embolism), thrombosis of dialysis access, and adverse events. The effects of homocysteine-lowering therapies on outcomes were assessed with meta-analyses using random-effects models. Prespecified subgroup and sensitivity analyses were conducted. We included six studies that reported data on 2452 participants with ESKD. Interventions investigated were folic acid with or without other vitamins (vitamin B6, vitamin B12). Participants' mean age was 48 to 65 years, and proportions of male participants ranged from 50% to 98%.Homocysteine-lowering therapy probably leads to little or no effect on cardiovascular mortality (4 studies, 1186 participants: RR 0.93, 95% CI 0.70 to 1.22). There was no evidence of heterogeneity among the included studies (I² = 0%). Homocysteine-lowering therapy had little or no effect on all-cause mortality or any other of this review's secondary outcomes. All prespecified subgroup and sensitivity analyses demonstrated little or no difference. Reported adverse events were mild and there was no increase in the incidence of adverse events from homocysteine-lowering therapies (3 studies, 1248 participants: RR 1.12, 95% CI 0.51 to 2.47; I(2) = 0%). Overall, studies were assessed as being at low risk of bias and there was no evidence of publication bias. Homocysteine-lowering therapies were not found to reduce mortality (cardiovascular and all-cause) or cardiovascular events among people with ESKD.

X Demographics

X Demographics

The data shown below were collected from the profiles of 9 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 222 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
South Africa 1 <1%
Unknown 220 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 39 18%
Student > Bachelor 28 13%
Student > Ph. D. Student 17 8%
Student > Postgraduate 14 6%
Researcher 10 5%
Other 42 19%
Unknown 72 32%
Readers by discipline Count As %
Medicine and Dentistry 68 31%
Nursing and Health Professions 21 9%
Biochemistry, Genetics and Molecular Biology 12 5%
Unspecified 9 4%
Psychology 8 4%
Other 28 13%
Unknown 76 34%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 September 2017.
All research outputs
of 25,383,278 outputs
Outputs from Cochrane database of systematic reviews
of 12,915 outputs
Outputs of similar age
of 349,014 outputs
Outputs of similar age from Cochrane database of systematic reviews
of 267 outputs
Altmetric has tracked 25,383,278 research outputs across all sources so far. This one has received more attention than most of these and is in the 74th percentile.
So far Altmetric has tracked 12,915 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 36.1. This one is in the 35th percentile – i.e., 35% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 349,014 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 72% of its contemporaries.
We're also able to compare this research output to 267 others from the same source and published within six weeks on either side of this one. This one is in the 37th percentile – i.e., 37% of its contemporaries scored the same or lower than it.