Symmetric Dimethylarginine in Cats with Hypertrophic Cardiomyopathy and Diabetes Mellitus

Abstract

BackgroundSymmetric dimethylarginine (SDMA) has been increasingly used as a marker of early chronic kidney disease (CKD) in cats, but little is known about the influence of comorbidities on SDMA in this species.HypothesisHypertrophic cardiomyopathy (HCM) and diabetes mellitus (DM), independently of CKD, are associated with changes in serum SDMA.AnimalsNinety‐four cats (17 with CKD, 40 with HCM, 17 with DM, and 20 healthy controls).MethodsCase‐control study. Clinical examination, echocardiography, ECG, blood pressure, CBC, biochemistry, thyroxine, and SDMA measurement were performed. Urinalysis was performed in controls and cats with CKD and DM. Analysis of variance was used to compare overall differences in the log‐transformed SDMA data among groups. A random forest algorithm was applied to explore which clinical and other factors influenced serum SDMA.ResultsMedian (range) serum SDMA for the renal group (positive control) was 19 (10–93) μg/dL, whereas for the control group (negative control), it was 10 (5–15) μg/dL. For the cardiac and diabetic groups, serum SDMA was 9 (4–24) μg/dL and 7 (3–11) μg/dL, respectively. The renal group had significantly higher SDMA concentrations and the diabetic group significantly lower SDMA concentrations compared to all other groups.Conclusions and Clinical ImportanceSerum SDMA concentrations in cats with HCM were not significantly different from those of healthy control cats. Cats with DM, however, had significantly lower SDMA concentrations than controls, a finding that needs further investigation and should be kept in mind when evaluating renal function of cats with this endocrinopathy.

Cardiovascular‐renal axis disorder and acute‐phase proteins in cats with congestive heart failure caused by primary cardiomyopathy

“…Cardiovascular‐renal disorder might not be present in the early stages of cardiomyopathy in cats, at least based on currently used marker panels, because we did not identify significant differences in serum SDMA and creatinine concentrations between preclinical cardiomyopathy cats and healthy controls. Similarly, a previous publication showed no significant increase in serum SDMA concentration in predominantly preclinical HCM cats 2 . Renal injury markers with higher sensitivity for detecting CvRD would be useful to investigate in the preclinical population 54…”

“…Biomarkers have drawn considerable attention in cardiovascular medicine in both the human medical and in veterinary fields. They may provide information on disease processes as well as assist in diagnosis and clinical management 1,2 . To date, commercially available cardiac biomarkers in veterinary medicine are limited to N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and cardiac troponin I (cTnI) 3 .…”

“…Unlike creatinine, SDMA is not affected by body lean mass, 17 and it can detect renal dysfunction earlier than does serum creatinine concentration 18,19 . Apart from a recent study comparing SDMA in cats with hypertrophic cardiomyopathy (HCM) and primary renal disease, 2 the biomarker role of SDMA in cats with heart disease has not been reported.…”

The new age of renal biomarkers: does SDMAsolve all of our problems?

“…Furthermore, no correlation has been found between the cardiac biomarker N‐terminal pro‐brain natriuretic peptide or between the liver enzymes alkaline phosphatase, alanine transaminase or aspartate aminotransferase and SDMA concentrations in dogs, providing preliminary although not complete evidence that cardiac disease including hypertrophic cardiomyopathy in cats (Langhorn et al . 2018) and hepatic disease have limited effect on SDMA (Relford et al . 2016).…”

“…However, significantly lower SDMA concentrations were observed in cats with diabetes mellitus (n=17) compared to controls (n=20) (Langhorn et al . 2018). This has also been reported in humans where lower serum SDMA concentrations have been reported in humans with poorly controlled type 2 diabetes compared to control (Can et al .…”