The effects of renal replacement therapy on plasma, asymmetric dimethylarginine, nitric oxide and C-reactive protein levels

Abstract

Clin Invest Med 2008; 31 (1): E1-E7. AbstractPurpose: Asymmetric dimethylarginine (ADMA), nitric oxide (NOx), and C-reactive protein (CRP) are important risk factors for endothelial dysfunction and mortality in the end stage renal diseases population. The aim of the study was to investigate the relationship between renal replacement therapy and endothelial dysfunction. Methods: Plasma NOx, ADMA and CRP levels were examined in randomized selected 30 patients with chronic kidney diseases (CKD), 28 patients receiving continuous ambulatory peritoneal dialysis (PD) and 30 patients receiving regular hemodialysis (HD) and age-matched 20 healthy controls. The duration of dialysis was from 4, 5 to 11, and 6 years, respectively. Results: CKD patients had higher plasma ADMA (1.26±0.53µmol/L) and CRP levels (1.02±025mg/L) and lower NOx levels (28.6±5.4µmol/L) than controls (0.45±0.20; 0.65± 0.45; 32.5±37 respectively, P<0.001).Plasma NOx and CRP levels were higher in HD patients (32.9±5.5µmol/L, P<0.05 and 4.59±3.18mg/L, P<0.001) and plasma ADMA and CRP levels were higher in PD patients (1.82±0.98µmol/L, P<0.001 and 2.40±1.53mg/L, P<0.001) than in CKD patients. PD patients had higher plasma ADMA levels (P<0.05) and lower plasma NOx and CRP levels than HD patients (P<0.001 and P<0.001). Plasma ADMA levels were negatively correlated with NOx levels in all patient groups (P<0.001). Plasma CRP levels in CKD and HD patients were positively correlated with plasma urea levels (r:0,437, P<0,001) and duration of dialysis (r:0,370, P<0.01), respectively. Conclusion: CRP and ADMA may be emerging as important risk factors for atherosclerosis in dialysis patients. Reduced NO elaboration secondary to accumulation of ADMA and elevated inflammation may be important pathogenic factors for endothelial dysfunction in both dialysis treatment strategies.

Plasma Nitrate and Incidence of Cardiovascular Disease and All‐Cause Mortality in the Community: The Framingham Offspring Study

“…In these studies, patients with renal impairment had elevated plasma NOx levels. These data are not unchallenged as some other studies report that NOx remains unchanged or even declines in renal failure . Moreover, net endogenous NOx generation may actually be lower in renal failure .…”

Asymmetric dimethyl arginine levels in chronic hemodialysis patients

“…This result is consistent with the previous similar studies in the literature regarding ADMA levels in ESRD patients (9,14,15). Circulating levels of ADMA had a positive correlation with levels of CRP.…”

“…In previous studies, ADMA levels were found to be higher in ESRD patients both on peritoneal dialysis and hemodialysis (HD) compared with healthy controls (8,9). Increased levels of ADMA are thought to be associated with the increased frequency of cardiovascular events seen in ESRD patients (10,11), and it is suggested that ADMA might be a novel cardiovascular risk factor for both ESRD patients and the general population (7,12).…”

Circulating Plasma Antioxidants, Inflammatory Markers and Asymptomatic Carotid Atherosclerosis in End-Stage Renal Disease Patients: A Case Control Study

“…Finally, plasma inflammation markers, such as CRP and fibrinogen, are elevated in predialysis and HD patients (44). In particular, CRP represent an important risk factor for endothelial dysfunction and mortality in the ESRD population, not significantly modified by administration/supplementation of antioxidant substances (45).…”