Plasma Asymmetric Dimethylarginine Level and the Association With Cardiovascular Risk Factors in End Stage Chronic Kidney Disease

Abstract

Objectives: we aimed to assess the levels of plasma ADMA in end stage renal disease (ESRD) patients without dialysis and its association with cardiovascular risk factors. Materials and Methods: This is a controlled cross-sectional study. Plasma ADMA level and other variables were measured in 30 patients of ESRD without dialysis and in 30 control healthy persons. Plasma ADMA levels were determined by enzyme linked immunosorbent assay (ELISA) using kits provided by immunodiagnostic AG, Germany. Data was analyzed by SPSS 19.0. Results: Mean level of ADMA in ESRD patients was 0.88 ± 0.27 µmol/L. Mean level of ADMA in healthy people was 0.49 ± 0.13 µmol/L, with significiant difference (p<0.01). There was not significiant difference of mean level of ADMA between male and female. Plasma ADMA levels were not correlated with age, serum CRP and cholesterol levels. There were correlation between ADMA level and BMI (r=-0.31, p<0.05), and Hb level (r=-0.58, p<0.01), and Hct (r=-0.60, p<0.01). It existed correlation between ADMA level and estimated glomerular filtration rate (GFR) (r=-0.63, p<0.01). Conclusion: In ESRD, mean level of ADMA is 0.88 ± 0.27 µmol/L. There is a significiant elevation of ADMA level in ESRD compared to healthy people. A negative correlation exists between ADMA level with BMI, Hb level, Hct and eGFR. Key words: Asymmetric dimethylarginine, end stage chronic kidney disease, cardiovascular risk factor, correlation.

New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature

“…A cross-sectional study conducted on 176 CKD patients showed a correlation between increasing plasma levels of ADMA and kidney function deterioration; moreover, stage 5 patients registered the highest elevation on ADMA plasma levels. The increase in ADMA was associated with by both eGFR < 60 mL/min/1.73 m 2 and anemia, two risk factors for CVD [84]. Inverse associations between eGFR and ADMA concentrations were also found in an elderly Korean cohort; in this study, the mean ADMA levels were significantly higher in subjects with eGFR < 60 mL/min/1.73 m 2 than in those with a higher eGFR [91].…”

“…Endothelial dysfunction begins in the early stages of CKD and progresses with renal disease severity [83][84][85][86], suggesting that it may be the key element linking CKD to the increased CV risk in these patients. The mechanisms underlying endothelial dysfunction in CKD include reduced nitric oxide (NO) production due to increased levels of endogenous NO synthase inhibitors, oxidative stress, inflammation, and vascular calcification [87,88].…”

Potential biomarkers of chronic kidney disease progression among kidney-derived proteins; a review

“…Some physiological factors, such as endothelial damage, cell senescence, glomerular hypertension and salt accumulation, lead to increased levels of ADMA, predicting the development of renal damage and the risk of cardiovascular disease among patients with end-stage renal disease. ADMA is a novel biomolecule that serves as a biomarker in CKD predicting eGFR<60 mL/min/1.73 m 2 with a sensitivity of 87% and specificity of 83% (19). Increased ADMA levels inhibit the synthesis of NO, thereby damaging endothelial function and stimulating renal impairment.…”