Inflammation and Asymmetric Dimethylarginine for Predicting Death and Cardiovascular Events in ESRD Patients

Tripepi, Giovanni; Mattace-Raso, Francesco; Sijbrands, Eric J.G.; Seck, Mamadou; Maas, Renke; Böger, Rainer H.; Witteman, Jacqueline C. M.; Rapisarda, Francesco; Malatino, Lorenzo; Mallamaci, Francesca; Zoccali, Carmine

doi:10.2215/cjn.11291210

Cited by 106 publications

(98 citation statements)

References 40 publications

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“…In another study, inflammation and endothelial dysfunction as assessed by circulating levels of ADMA were found to be an independent factor for explaining all-cause mortality and cardiovascular events in ESRD patients (18). Similar to this finding, a recent study also reported that ADMA level is a death predictor in ESRD patients (22).…”

Section: Discussionsupporting

confidence: 56%

“…This finding might suggest that a connection exists between endothelial dysfunction and inflammation in ESRD patients. Recently some studies pointed out the association of ADMA levels with biomarkers of inflammation in some chronic conditions like familial Mediterranean fever, inflammatory bowel disease, and chronic kidney disease (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

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Asymmetric dimethyl arginine levels in chronic hemodialysis patients

Çi̇fci̇¹,

İnal²,

Kaya³

2014

Turk J Med Sci

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Asymmetric dimethyl arginine levels in chronic hemodialysis patients

Çi̇fci̇¹,

İnal²,

Kaya³

2014

Turk J Med Sci

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“…Those with a CRP > 5 have an increased mortality compared to patients below that threshold [138] and there is a Jshaped association between hsCRP and mortality suggesting that RTRs with very low hsCRP may also be at increased risk of death [139] . More novel markers such as asymmetric dimethylarginine, which is associated with endothelial dysfunction, are also associated with higher risk of mortality (HR = 2.18) and developing CVD (HR = 2.59) in ESRD [140] . Poorer graft outcomes are predicted by IL-6 [136,141] and elevated symmetric dimethylarginine [142] (HR = 5.51).…”

Section: Inflammationmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

117

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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“…The latest study from Tripepi et al [40] showed that inflammation amplified the risk of all-cause mortality and cardiovascular mortality in association with high ADMA levels in this population. However, the prognostic values of ADMA and CRP from this study couldn't be compared with prognostic values from our own study due to the fact that different statistical methods have been applied.…”

Section: Discussionmentioning

confidence: 83%

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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Inflammation and Asymmetric Dimethylarginine for Predicting Death and Cardiovascular Events in ESRD Patients

Cited by 106 publications

References 40 publications

Asymmetric dimethyl arginine levels in chronic hemodialysis patients

Asymmetric dimethyl arginine levels in chronic hemodialysis patients

Cardiovascular risk factors following renal transplant

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

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