Dimethylarginines and inflammation markers in patients with chronic kidney disease undergoing dialysis

Öner-İyidoğan, Yıldız; Öner, Pernur; Koçak, Hikmet; Gürdöl, Figen; Bekpınar, Seldağ; Ünlüçerçi, Yeşim; Çalışkan, Yaşar; Çetinalp-Demircan, Pınar; Koçak, Taner; Türkmen, Aydın

doi:10.1007/s10238-009-0035-3

Cited by 20 publications

(21 citation statements)

References 32 publications

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“…Our arginine results were in accord with OnerIyidogan et al (21). It has been demonstrated that CKD patients lose L-arginine during dialysis (25).…”

Section: Discussionsupporting

confidence: 92%

“…In previous studies, conflicting findings have been reported about the effect of CAPD and HD on ADMA levels (20)(21)(22)(23) (23) reported that ADMA concentrations were higher in patients undergoing HD than those having CAPD. Iyidogan et al reported that ADMA concentrations of HD and CAPD groups were higher than those of controls and HD group had significantly higher levels of ADMA than those of CAPD group.…”

Section: Discussionmentioning

confidence: 99%

“…Iyidogan et al reported that the decline in plasma arginine levels might result from the dialysis-mediated losses of this amino acid (21). Arginine loss might be involved in the mechanism of endothelial damage seen after a longterm dialysis treatment (21).…”

Section: Discussionmentioning

confidence: 99%

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Asymmetric Dimethylarginine and Homocysteine Levels in Dialysis Patients

Erdem¹,

Yerlikaya

Tonbul

et al. 2013

ELECTRON J GEN MED

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Cardiovascular diseases and endothelial disfunction are major causes of mortality in patients with end stage renal disease (ESRD). Treatment strategies like continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) have different effects on different parameters. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide (NO) synthase inhibitor and it has been reported to be a novel marker for the progression of chronic kidney disease (CKD). 91 MATERIAL AND METHODS PatientsThis study was performed on 44 (23M, 21F) CAPD patients (four exchanges of 2 L dialysate / day containing varying glucose concentrations to obtain adequate ultrafiltration) at least 6 months under dialysis, aged 38-65 years, 26 (13M,13F) HD patients at least 6 months under dialysis, aged 35-68 years and 29 (15M, 14F) healthy control subjects, aged 35-64 years. HD session duration was approximately four hours and it was applied three times a week using unfractionated heparin for anticoagulation. Exclusion criteria for the study included malignant disease, chronic liver disease, infectious disease, chronic respiratory insufficiency, rheumatoid arthritis, pregnancy, alcohol and smoking habit. All patients maintained the usual dialysis diet. Control subjects were on a free mediterranean diet. All anthropometric measurements were made with participants wearing light clothing and no shoes. Body mass index (BMI) was measured in all participants. The study protocol was approved by the Ethics Committee of Meram Medical School, University of Selcuk, Konya, Turkey. All patients were informed of the details of the study and the written consent of each patient was received. Laboratory investigationsBlood samples were taken immediately before the first dialysis session of the week. Venous blood samples were obtained in the morning after a 12 h fasting. Serum samples were obtained after centrifugation (4000 rpm for 10 min at 4 oC) and samples were stored frozen at -80 oC until ADMA, arginine, homocysteine analysis. Serum lipids and CRP levels were measured immediately.

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“…Our arginine results were in accord with OnerIyidogan et al (21). It has been demonstrated that CKD patients lose L-arginine during dialysis (25).…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Asymmetric Dimethylarginine and Homocysteine Levels in Dialysis Patients

Erdem¹,

Yerlikaya

Tonbul

et al. 2013

ELECTRON J GEN MED

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“…inflammation has been demonstrated (34,35). A partly discrepant finding was reported by Zoccali et al, who found normal ADMA in patients with acute inflammation and underlying chronic disease with a variable degree of renal insufficiency and a rise in ADMA once the source of inflammation was treated; no such association was found for SDMA (36).…”

Section: Discussionmentioning

confidence: 89%

Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease

Schepers¹,

Barreto²,

Liabeuf³

et al. 2011

Clinical Journal of the American Society of Nephrology

125

104

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SummaryBackground & objectives Chronic kidney disease (CKD) is characterized by chronic inflammation, considered a nontraditional risk factor for cardiovascular disease, the major cause of death in CKD. Symmetric dimethylarginine (SDMA) was recently demonstrated to induce reactive oxygen species in monocytes. The present study further investigates the inflammatory character of SDMA compared with its structural counterpart asymmetric dimethylarginine (ADMA). Design, setting, participants, & measurementsIn vitro, the effect of SDMA on intracellular monocytic expression of IL-6 and TNF-␣ was studied followed by an evaluation of nuclear factor (NF)-B activation. Additionally, an association of SDMA with inflammatory parameters in consecutive stages of CKD was evaluated in vivo.Results Monocytes incubated with SDMA showed increased IL-6 and TNF-␣ expression and a rise in active NF-B. N-acetylcysteine abrogated both these effects. No significant effects were observed with ADMA. In vivo, 142 patients (67 Ϯ 12 years) at different stages of CKD showed an inverse association between serum SDMA and ADMA and renal function. Correlations between SDMA and IL-6, TNF-␣, and albumin were more significant than for ADMA, while multiple regression analysis only retained TNF-␣ at a high significance for SDMA (P Ͻ 0.0001). In receiver operating characteristic analysis for inflammation, defined as an IL-6 level above 2.97 pg/ml (median), the discriminative power of SDMA (area under the curve [AUC]: 0.69 Ϯ 0.05) directly followed that of C-reactive protein (AUC: 0.82 Ϯ 0.04) and albumin (AUC: 0.72 Ϯ 0.05; for all, P Ͻ 0.0001) and preceded that of ADMA (P ϭ 0.002). ConclusionsThe present study shows that SDMA is involved in the inflammatory process of CKD, activating NF-B and resulting in enhanced expression of IL-6 and TNF-␣, which is corroborated by the clinical data pointing to an in vivo association of SDMA with inflammatory markers in CKD at different stages.

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“…In particular, ADMA levels were elevated more in the patients undergoing hemodialysis than in the ones undergoing peritoneal dialysis. Results from this study suggested that patients on hemodialysis are more prone to inflammation and/or oxidative stress [6]. According to Zoccali et al [7], there are four mechanisms that may explain increased level of ADMA: increased methylation of proteins, increased protein turnover, reduced DDAH activity and impaired renal excretion.…”

Section: Introductionmentioning

confidence: 70%

ADMA and C-reactive protein as mortality predictors in dialysis patients

Ignjatović¹,

Cvetković²,

Pavlović

et al. 2013

Open Medicine

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AbstractThere is a higher mortality between patients with end-stage renal disease than patients in the general population. These circumstances have led to a search for risk factors as predictors of mortality in dialysis patients. Amongst those, inhibitors of the nitric-oxide (NO) synthesis deserve special attention, since patients with end-stage renal disease are also characterized by accelerated atherosclerosis. Asymmetric-dimethylarginine (ADMA) and symmetric-dimethylarginine (SDMA), as well as C-reactive protein (CRP), have also been recognized as predictors of mortality in patients on dialysis. The aim of our study was to compare the prediction power of ADMA, SDMA and CRP for all-cause mortality in patients with end stage renal disease during the fourteen month follow-up. In total 162 patients on hemodialysis were included. ADMA and SDMA were measured by the high-performance liquid chromatography (HPLC); CRP was measured using immunonephelometric assays. During the 14-month period 28 patients (34.1%) died from all-cause mortality. Using univariate analysis, hazard ratios (HR) of the potential independent predictors of mortality in hemodialysis patients were ADMA (HR 1.39 (1.01–1.91) p=0.043) and CRP (HR 1.024 (1.009–1.1.040) p=0.001). Further, multivariate analysis (MVA), however, showed that ADMA is the only predictor of all-cause mortality (HR 1.76 (1.002–3.11) P=0.049), while SDMA failed to predict death in this population. Therefore, our data shows that ADMA is an independent and better marker of all-cause mortality compared with CRP.

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Dimethylarginines and inflammation markers in patients with chronic kidney disease undergoing dialysis

Cited by 20 publications

References 32 publications

Asymmetric Dimethylarginine and Homocysteine Levels in Dialysis Patients

Asymmetric Dimethylarginine and Homocysteine Levels in Dialysis Patients

Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease

ADMA and C-reactive protein as mortality predictors in dialysis patients

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