title: Circulating levels of asymmetric dimethylarginine are an independent risk factor for left ventricular hypertrophy and predict cardiovascular events in pre-dialysis patients with chronic kidney disease.
abstract: BACKGROUND
  Several studies have related the circulating level of asymmetric dimethylarginine (ADMA) to cardiac remodeling and cardiovascular (CV) events in end-stage renal disease (ESRD) patients. Studies investigating this relationship in patients with pre-dialysis chronic kidney disease (CKD) are lacking.
  
  
  METHODS
  We enrolled 76 CKD patients (age, 46.7+/-14.3 years, 39 females) and 15 controls (age, 40.1+/-18.5 years, 6 females). Clinical parameters, blood biochemistry and echocardiographic findings were recorded, and plasma ADMA concentrations measured by high-performance liquid chromatography-mass spectrometry (HPLC-MS). Patients were prospectively followed up for a median of 15 (range, 6-24) months.
  
  
  RESULTS
  Plasma ADMA was significantly elevated in CKD patients compared with controls (41.56+/-12.76 microg/mL vs 17.12+/-7.09 microg/mL, P<0.001), and correlated with the left ventricular mass index (LVMI) (r=0.597, P<0.001). During follow-up, 25 patients experienced new CV events and their plasma ADMA level was significantly elevated (48.27+/-13.70 vs 34.91+/-6.38 in CV event-free patients, P<0.001). Cox regression analysis further confirmed that ADMA was an independent risk factor for CVD (HR=1.175, 95%CI[1.070-1.290], P=0.001).
  
  
  CONCLUSIONS
  Similar to findings in ESRD patients, elevated circulating levels of ADMA may increase the risk of LVH and CV events in pre-dialysis CKD patients.
authors.affiliation: Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630 Dongfang Road, Shanghai, PR China.
authors.forename: Beili
authors.initials: B
authors.lastname: Shi
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Ni
authors.forename: Wenyan
authors.initials: W
authors.lastname: Zhou
authors.forename: Zanzhe
authors.initials: Z
authors.lastname: Yu
authors.forename: Leyi
authors.initials: L
authors.lastname: Gu
authors.forename: Shan
authors.initials: S
authors.lastname: Mou
authors.forename: Wei
authors.initials: W
authors.lastname: Fang
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Liou
authors.initials: L
authors.lastname: Cao
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Yan
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Qian
mesh_terms: D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine