title: No benefit of hemodiafiltration over hemodialysis in lowering elevated levels of asymmetric dimethylarginine in ESRD patients.
abstract: BACKGROUND
  It has been suggested that hemodiafiltration (HDF) is more efficient than hemodialysis (HD) in lowering plasma levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), which is a strong and independent predictor of overall mortality in ESRD patients.
  
  
  METHODS
  Twenty ESRD patients (11 women) were studied during both a single online HDF session and a single HD session. In each patient, ADMA, L-arginine, SDMA, beta(2)-microglobulin and urea were measured at several time points.
  
  
  RESULTS
  Although HDF was clearly superior to HD in decreasing plasma beta(2)-microglobulin, there was no difference in the elimination characteristics of ADMA. However, HDF but not HD eliminated the nitric oxide synthase substrate L-arginine, making HD superior in increasing the L-arginine/ADMA ratio.
  
  
  CONCLUSIONS
  Neither HD nor HDF sufficiently removes the putative uremic toxin ADMA. The clinical significance of HD better improving the L-arginine/ADMA ratio (parameter of NO production) as compared to HDF needs to be determined.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Diagnostics,Charles University and General University Hospital, Prague, Czech Republic.
authors.forename: Marta
authors.initials: M
authors.lastname: Kalousová
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Magdaléna
authors.initials: M
authors.lastname: Hodková
authors.forename: Tomás
authors.initials: T
authors.lastname: Zima
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dusilová-Sulková
authors.forename: Jens
authors.initials: J
authors.lastname: Martens-Lobenhoffer
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Bode-Boger
mesh_terms: D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood / Q000652:urine; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy / Q000652:urine; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D001613:beta 2-Microglobulin; D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D001120:Arginine; D019001:Nitric Oxide Synthase