title: Sympathetic nerve traffic and asymmetric dimethylarginine in chronic kidney disease.
abstract: OBJECTIVE
  Sympathetic overactivity and high levels of the endogenous inhibitor of NO synthase asymmetric dimethylarginine (ADMA) are prevalent risk factors in chronic kidney disease (CKD).
  
  
  METHODS
  In 48 stage 2 to 4 CKD patients, we investigated the relationship between efferent postganglionic muscle sympathetic nerve traffic (microneurography) and circulating ADMA and analyzed the links between these risk factors and estimated GFR (eGFR), proteinuria, and different parameters of left ventricular (LV) geometry.
  
  
  RESULTS
  CKD patients characterized by sympathetic nerve traffic values in the third tertile showed the highest ADMA levels, and this association was paralleled by a continuous, positive relationship between these two risk factors (r = 0.32, P = 0.03) independent of other confounders. Both sympathetic nerve traffic and ADMA were inversely related to eGFR and directly to proteinuria and LV geometry. Remarkably, the variance of eGFR, proteinuria, and LV geometry explained by sympathetic nerve traffic and ADMA largely overlapped because sympathetic nerve traffic but not ADMA was retained as a significant correlate of the eGFR (P < 0.001) and of the relative wall thickness or the left ventricular mass index/LV volume ratio (P = 0.05) in models including both risk factors. ADMA, but not sympathetic nerve traffic, emerged as an independent correlate of proteinuria (P = 0.003) in a model including the same covariates.
  
  
  CONCLUSIONS
  Sympathetic activity and ADMA may share a pathway leading to renal disease progression, proteinuria, and LV concentric remodeling in CKD patients.
authors.affiliation: Clinica Medica, Ospedale San Gerardo, Monza (Milan), Department of Prevention and Clinical Medicine, University of Milano-Bicocca, Milan, Italy. guido.grassi@unimib.it
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Gino
authors.initials: G
authors.lastname: Seravalle
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ghiadoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Bruno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D007558:Italy; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D011507:Proteinuria / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017779:Sympathetic Fibers, Postganglionic / Q000503:physiopathology*; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine