Asymmetric Dimethylarginine and Progression of Chronic Kidney Disease - a One-Year Follow-Up Study

• Published in: Kidney & blood pressure research Vol. 39; no. 1; pp. 50 - 57
• Main Authors: Eiselt, Jaromír, Rajdl, Daniel, Racek, Jaroslav, Vostrý, Michal, Rulcová, Kamila, Wirth, Jan
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2014; Karger Publishers
• Subjects: ADMA; Advanced glycation end products; Advanced oxidation protein products; Advanced Oxidation Protein Products - blood; AGE; Aged; AOPP; Arginine - analogs & derivatives; Arginine - blood; Asymmetric dimethylarginine; Biomarkers - blood; Case-Control Studies; Chronic kidney disease; Chronic kidney disease progression; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Glycation End Products, Advanced - blood; Humans; Longitudinal Studies; Male; Middle Aged; Original Paper; Oxidative stress; Oxidative Stress - physiology; Prognosis; Prospective Studies; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - physiopathology; AOPP; Oxidative stress; Advanced glycation end products; Advanced oxidation protein products; Chronic kidney disease progression; Asymmetric dimethylarginine; ADMA; Chronic kidney disease; AGE
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000355776

Background/Aims: 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). Conclusion: 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.