title: Asymmetric dimethylarginine predicts the risk of contrast-induced acute kidney injury in patients undergoing cardiac catheterization.
abstract: Decreased nitric oxide (NO) bioavailability and increased oxidative stress may be involved in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). The relationship between asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor, and CI-AKI is unknown.
  
  
  
  We measured plasma ADMA levels in 664 consecutive subjects undergoing cardiac catheterization. Mehran score for predicting the risk of CI-AKI was calculated.
  
  
  
  After cardiac catheterization, 78 (11.7%) patients experienced CI-AKI (defined as increase of serum creatinine levels of ≥0.3 mg/dl or a 25% increase from baseline value at 48 h after the procedure). The plasma ADMA levels of patients with CI-AKI were significantly higher than those of patients without CI-AKI (0.50 ± 0.09 μmol/l versus 0.46 ± 0.10 μmol/l, p < 0.001). The c-statistics of plasma ADMA level and Mehran score for the occurrence of CI-AKI were 0.639 (95% CI: 0.601-0.676, p < 0.001) and 0.615 (95% CI: 0.577-0.652, p = 0.001), respectively. By using a cutpoint of plasma ADMA level of 0.42 μmol/l, the analysis would yield 85.9% sensitivity, 37.0% specificity. Adding the plasma ADMA level to the Mehran score system marginally increases the c-statistic from 0.615 to 0.643 (p = 0.03). Furthermore, in patients developing CI-AKI, those with plasma ADMA levels >0.42 μmol/l (14 events in 52 patients) tended to have a higher 1-year major adverse event rate than those with plasma ADMA level ≤0.42 μmol/l (2 events in 26 patients) (p = 0.055).
  
  
  
  In patients undergoing cardiac catheterization, ADMA might be a novel risk factor of CI-AKI.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: tmlu@vghtpe.gov.tw.
authors.forename: Tse-Min
authors.initials: TM
authors.lastname: Lu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chiao-Po
authors.initials: CP
authors.lastname: Hsu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei City Hospital-Heping Branch, Taipei, Taiwan, ROC.
authors.forename: Chao-Fu
authors.initials: CF
authors.lastname: Chang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Physiology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tzong-Shyuan
authors.initials: TS
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Wan-Leong
authors.initials: WL
authors.lastname: Chan
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology*; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000737:chemistry; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D001120:Arginine
keywords: Asymmetric dimethylarginine; Contrast medium; Contrast-induced acute kidney injury; Nitric oxide