title: Asymmetric dimethylarginine and progression of chronic kidney disease: a one-year follow-up study.
abstract: OBJECTIVE
  Asymmetric dimethylarginine (ADMA) is a prognostic factor in patients with chronic kidney disease (CKD). However, the relationships among factors influencing the metabolism of ADMA and the CKD progression are not fully understood.
  
  
  METHODS
  Serum ADMA, and variables related to the metabolism of ADMA were measured in 181 non-dialysis patients (CKD stages 3-5) and in 46 controls. Patients were assessed at baseline, and 6 and 12 months after the initiation of the study.
  
  
  RESULTS
  Patients had increased baseline ADMA, advanced glycation end products (AGE), and advanced oxidation protein products (AOPP) compared with controls (P<0.001). In a total of 164 patients who completed a one-year study, the estimated GFR (eGFR) declined from 23.5 (17.7-36) mL/min/1.73m(2) to 21 (14.7-31.5) (P=0.018), AGE rose from 1.58 (1.38-1.90) μmol/L to 1.76 (1.52-2.21) (P<0.001), while ADMA, AOPP, tubular function, and proteinuria remained stable. In a multiple regression model (adjusted R(2) = 0.49, P<0.0001), the interaction of relatively higher baseline eGFR, i.e. > 25 mL/min/1.73m(2), with higher ADMA (P=0.02) and higher AOPP (P=0.04) predicted the severest decrease in eGFR per year. Other predictors of progression were higher baseline AGE (P<0.001), proteinuria (P=0.003), hypertension (P=0.01), and higher baseline eGFR (P=0.03).
  
  
  CONCLUSIONS
  Elevated ADMA and markers of oxidative stress were strong predictors of progression in patients with eGFR between 25-40 mL/min/1.73m(2) , i.e. at the borderline of CKD stages 3-4.
authors.affiliation: Department of Internal Medicine I, Charles University, Medical School and Teaching Hospital Plzeň, Czech Republic.
authors.forename: Jaromír
authors.initials: J
authors.lastname: Eiselt
authors.forename: Daniel
authors.initials: D
authors.lastname: Rajdl
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Racek
authors.forename: Michal
authors.initials: M
authors.lastname: Vostrý
authors.forename: Kamila
authors.initials: K
authors.lastname: Rulcová
authors.forename: Jan
authors.initials: J
authors.lastname: Wirth
mesh_terms: D062107:Advanced Oxidation Protein Products / Q000097:blood; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D017127:Glycation End Products, Advanced / Q000097:blood; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D062107:Advanced Oxidation Protein Products; D015415:Biomarkers; D017127:Glycation End Products, Advanced; C018524:N,N-dimethylarginine; D001120:Arginine