RESUMO
Indian population is usually deficient in folic acid. Aim was to study the plasma homocysteine and antioxidant status in type 2 diabetics and healthy individuals before and after folate therapy. Methods: This study was done in four groups of 25 cases each. These included: type 2 diabetics with end stage diabetic chronic kidney disease (CKD) (group A); diabetic renal allograft recipients with normal and stable graft function (group B); uncomplicated type 2 diabetics (group C); and age and sex matched healthy controls (group D). The serum homocysteine and total antioxidant status (TAS) were measured at baseline and after 4 weeks of folate therapy. Results: The plasma homocysteine levels were 18.163.80, 16.150.66, 12.480.82 and 23.361.61 mol/L in group A, B, C and D respectively. The homocysteine levels were significantly low in all diabetic groups when compared to healthy controls. The plasma homocysteine were significantly elevated in stage 5 diabetic CKD and diabetic renal transplant recipients as compared to uncomplicated diabetics. After four weeks of folate therapy, there was a significant decrease of homocysteine in all the groups. The mean values of TAS were 1.42 0.18, 1.49 0.18, 1.17 0.06 and 1.60 0.86 pg/ml in group A, B, C and D respectively. There was no significant correlation between diabetic groups and healthy controls. No change was observed in TAS levels after folate therapy. Conclusions: Our results show significant hyperhomocysteinemia in healthy Indians. Plasma homocysteine were significantly low in all diabetic groups as compared to healthy individuals. We suggest supplementation of Indian diet with folic acid.
RESUMO
Background & objectives: Chronic kidney disease (CKD) patients on dialysis regularly receive erythropoiesis stimulating agent (ESA) for treating renal anaemia during their dialysis unlike those who are not on dialysis. In such patients, the longer acting ESA can be helpful in reducing their frequent visits to the health care facilities and improving their compliance. This study was aimed to examine the efficacy and safety of continuous erythropoietin receptor activator (CERA), a long acting ESA in treating renal anaemia in patients with diabetic CKD not on dialysis. Methods: In this prospective, open-labelled, pilot clinical study, 35 adult type 2 diabetes patients with nephropathy and renal anaemia, who were not on dialysis nor receiving treatment with ESA were administered CERA subcutaneously once in two weeks for a period of 24 weeks. The primary efficacy end point was to evaluate the Hb response (Hb rise of ≥1 g/dl above the baseline or Hb level ≥11 g/dl) during the study period. Results: All patients showed Hb rise ≥1 g/dl during the study period and 80 per cent patients could achieve Hb value ≥11 g/dl. The maximum median Hb rise of 1.2 g/dl occurred in the initial 6 weeks after starting the treatment. The mean creatinine clearance (CrCl) improved by 2.8 ml/min, with mean Hb rise of 2.6 g/dl from the baseline after administration of CERA. Worsening of blood pressure (BP) control (42.9%) was the most common adverse event. Interpretation & conclusions: CERA once in two weeks was found to be efficacious in correcting anaemia in the ESA-naïve patients with diabetic nephropathy who are not on dialysis. However, regular monitoring of blood pressure is required while on treatment with CERA.