Asymmetric dimethylarginine represents a precious risk indicator for radial artery calcification in patients with advanced kidney disease

Abstract

INTRODUCTION Medial arterial calcification is common in patients with chronic kidney disease (CKD) and is considered a risk factor for morbidity and mortality. OBJECTIVES We aimed to evaluate the correlation between asymmetric dimethylarginine (ADMA) levels, radial artery calcification, and common carotid artery intima-media thickness (CCA‑IMT). PATIENTS AND METHODS The study included 51 patients with CKD, in whom an arteriovenous fistula for hemodialysis access was created to collect radial artery samples for a histological examination, and 33 healthy volunteers, in whom the reference concentrations of ADMA were assessed. The concentrations of creatinine, albumin, calcium, phosphate, fibroblast growth factor 23, osteoprotegerin (OPG), osteopontin (OPN), osteocalcin, secreted protein acidic and rich in cysteine, interleukin 6, interleukin 18, pentraxin 3, stromal cell‑derived factor 1α (SDF1α), thrombomodulin, soluble tumor necrosis factor receptor II (sTNFRII), and matrix metalloproteinase 2 (MMP‑2) were determined. Radial artery fragments were stained for calcifications using alizarin red. The CCA‑IMT was assessed by ultrasonography. RESULTS Patients with CKD had higher ADMA levels than controls. Patients with ADMA levels above the median were older, had higher levels of phosphate, fibroblast growth factor 23, OPG, OPN, PTX3, sTNFRII, MMP‑2, thrombomodulin, and they had more atherosclerotic plaques in the carotid artery. In multiple regression, log‑transformed (log)sTNFRII, MMP‑2, and SDF1α levels were independent predictors of log(ADMA). Patients with calcifications had higher ADMA levels. A similar correlation was observed between SDF1α and alizarin red staining grades 1 to 3. In logistic regression, ADMA levels positively predicted the presence of calcifications independently of age, hemodialysis status, Framingham risk score, and PTX3. CONCLUSIONS Circulating ADMA levels indicate medial arterial calcification in patients with CKD.

Effect of a Supervised Peridialytic Exercise Program on Serum Asymmetric Dimethylarginine in Maintenance Hemodialysis Patients

“…The significant increase of S. ADMA during the study period was paralleled by a significant increase of S. phosphorus and an insignificant increase of CA × Ph product ( Table 1 ). This came in line with a study of 51 patients with advanced CKD, in whom log plasma ADMA had significant positive correlations with log S. phosphorus, Ca × Ph product, and fibroblast growth factor-23 (FGF-23) [ 59 ]. Similarly, within 259 MHD patients, those in higher quartiles of S. ADMA were more likely to have higher S. phosphorus and FGF-23 [ 60 ].…”

“…Therefore, a relation between increasing circulating ADMA and increasing S. phosphorus and Ca × Ph product in patients with advanced CKD and ESRD likely exists. It remains to be elucidated whether such a relation is mediated through parathyroid hormone [ 61 ], FGF-23 [ 59 , 60 , 62 ], or other unidentified factors.…”

Plasma Urea Cycle Metabolites May Be Useful Biomarkers in Children With Eosinophilic Esophagitis

“…Elevations of both asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) have been shown to play multifunctional roles in many human diseases (12) and are implicated in promoting endothelial injury (11). High levels of ADMA have been associated with cardiovascular disease (11), chronic kidney disease (13), and poor outcomes in asthma (14). Similarly, ADMA and SDMA levels have been shown to be significantly elevated in patients with inflammatory bowel disease (15), and chronic lymphocytic leukemia (16).…”

Proteoglycan/glycosaminoglycan and collagen content in the arterial wall of patients with end-stage renal disease – new indicators for vascular disease

“…This adds to our earlier report on the association between medial arterial calcification and SDF -1 and sTM levels. 6,23 The levels of SDF -1 and sTM were also shown to be positively correlated with matrix alterations (high grade of alcian blue staining). Thrombomodulin is a PG lining the endothelial…”

“…In this cross -sectional study, we adopted a methodology similar to our previous investigations, 6,19,20 which were conducted as part of a completed research initiative, designed by KK, at the Department of Nephrology of Jagiellonian University Medical College in Kraków, Poland. However, the assessment of alcian blue and sirius red staining of the arterial wall in relation to vascular morphology and a panel of biochemical parameters is unique to this study and has not been reported before.…”