Context

Hyperhomocysteinemia increases oxidative stress, a common pathogenic mechanism of injury in chronic kidney disease (CKD) and atherosclerosis.1 Plasma homocysteine has been linked to worsening diabetic nephropathy,2 but no therapeutic trials have assessed the effect of vitamin-based, homocysteine-lowering therapy on slowing the progression of disease. Moreover, hyperhomocysteinemia has been associated with an increased incidence of cardiovascular (CV) disease,3 and participants with impaired kidney function have elevated plasma homocysteine. House and colleagues sought to determine whether B-vitamin therapy reduces progression of CKD and incidence of CV events in participants with diabetic nephropathy.