Mesna for the treatment of hyperhomocysteinemia in hemodialysis patients.
BACKGROUND
Increased plasma total homocysteine (tHcy) is a risk factor for the development of atherosclerosis and thrombosis present in over 90% of patients with end-stage renal disease (ESRD). We hypothesized that 12 mg/kg intravenous mesna administered predialysis would cause a significant decrease in plasma tHcy compared to placebo.


METHODS
Patients with ESRD were recruited for 1- and 4-week placebo-controlled, cross-over studies. Intravenous 12 mg/kg mesna or placebo was administered 3 times weekly predialysis.


RESULTS
One week of 12 mg/kg intravenous mesna significantly decreased predialysis plasma tHcy by 12.8 +/- 7.8% (placebo 23.4 +/- 8.0 micromol/l vs. mesna 20.5 +/- 7.6 micromol/l, p = 0.0044). Four weeks of treatment yielded no significant decline in predialysis plasma tHcy (placebo 18.3 +/- 8.5 micromol/l vs. mesna 18.7 +/- 6.3 micromol/l, p = 0.41).


CONCLUSIONS
Although 12 mg/kg mesna significantly enhances tHcy excretion, prolonged treatment causes no change in plasma tHcy.
Cutler
Murray J
MJ
Division of Clinical Pharmacology, University of Western Ontario, London, Ont., Canada.
Urquhart
Bradley L
BL
Freeman
David J
DJ
Spence
J David
JD
House
Andrew A
AA
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D015080:Mesna / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis / Q000009:adverse effects*
D006710:Homocysteine; D015080:Mesna