Serum ADMA, endothelial dysfunction, and atherosclerosis in hypervolemic hemodialysis patients

Abstract

Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patientsunder hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA inhemodialysis patients.Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP weremeasured. Echocardiographic evaluation and carotid artery intima–media thickness (CIMT) measurements were performed. Patientswere divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracicindex (CTI); the two groups were hypervolemic and normovolemic.Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in thehypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statisticallysignificant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 µmol/L and 0.41± 0.04 µmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P< 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejectionfraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associatedwith age, systolic blood pressure, CTI, and volume status.Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment.