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Vitamin B6, B9 and B12 in diabetic nephropathy—beware

Nature Reviews Endocrinology volume 6, pages 477–478 (2010)Cite this article

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Combination therapy with vitamins B6, B9 and B12 is a therapeutic intervention to decrease levels of plasma homocysteine and the risk of cardiovascular disease. However, a recent trial found that cosupplementation with these vitamins exacerbated the decline in renal function and increased the risk of vascular disease in patients with diabetic nephropathy. Confidence in this high-dose vitamin supplement is shaken.

High concentrations of plasma total homocysteine are known to be associated with the risk of developing diabetes-related cardiovascular disease, nephropathy and proliferative retinopathy. Cosupplementation of pyridoxine (vitamin B6), folic acid (vitamin B9) and vitamin B12 has been used to decrease levels of plasma homocysteine and the risk of cardiovascular disease. A study by House et al.1 has now shown substantial adverse outcomes associated with high-dose vitamin B6, B9 and B12 cosupplementation in patients with advanced diabetic nephropathy. Unless other explanations come to light in further analyses of this study, these findings make repetition of a similar trial in this high-risk patient group unethical.

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Acknowledgements

The authors thank Diabetes UK and the British Heart Foundation for supporting their research on diabetes mellitus and cardiovascular disease.

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  1. Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, University Hospital, Clifford Bridge Road, CV2 2DX, Coventry, UK

    Paul J. Thornalley & Naila Rabbani

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  1. Paul J. Thornalley
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Correspondence to Paul J. Thornalley.

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Competing interests

The authors declare an association with the following company: Merck Serono. P. J. Thornalley received a research grant from Merck Serono for the project “Epidemiological cross-sectional study on B-vitamin acid status in South-East Asian diabetic patients” conducted in 2008–2009. P. J. Thornalley and N. Rabbani have received speakers honoraria from Merck Serono.

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Thornalley, P., Rabbani, N. Vitamin B6, B9 and B12 in diabetic nephropathy—beware. Nat Rev Endocrinol 6, 477–478 (2010). https://doi.org/10.1038/nrendo.2010.124

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