You are here

Home » Content

Kronik Böbrek Yetmezliği Hastalarında Koroner Arter Hastalığı Ciddiyeti ile “Asymmetrical Dimethylarginine” Arasındaki İlişki

Association Between Asymmetric Dimethylarginine and the Severity of Coronary Artery Disease in Patients with Chronic Kidney Disease

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2011
DOI: 
DOI 10.5262/tndt.2011.1001.10

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
ObjectI ve: Cardiovascular diseases are the most common cause of death in patients with endstage renal disease. Asymmetrical dimethylarginine (ADMA) is increased in conditions associated with increased risk of atherosclerosis. We aimed to examine the association between severity of coronary stenosis and the ADMA levels in a group of chronic kidney disease (CKD) stage 1 to 3. MA TERIAL and Metho ds: Eighty-eight (88) consecutive patients with decreased renal function (glomerular filtration rate (GFR) between 90 and 30 ml/min), undergoing cardiac catheterization for proven or clinically suspected coronary artery disease were enrolled at the study. Serum levels of creatinine, ADMA, nitric oxide (NO), calcium, phosphate, total cholesterol, HDL and LDL fractions, triglycerides were determined using measurement techniques. The Gensini scoring system was used for the detection of the severity of coronary atherosclerosis. Res ults : The mean serum values were 81.48 ± 13.8 micromol/l for ADMA and 3.7 ± 1.7 mmol/L for NO. The mean Gensini score in the study group was 30.4 ± 40.1. All patients were classified into tertiles of Gensini score level. Patients in the highest tertile had statistically significantly lower GFR values. The ADMA values increased statistically significantly in the third tertile compared with the first tertile. The Gensini score values significantly correlated in univariate analysis with the GFR, ADMA and presence of hypertension. In a multivariate regression model, ADMA was the only statistically significant independent predictor of Gensini score. ConclusIo n: ADMA appears to be one of the strongest risk markers for atherosclerosis in patients with mild and moderate CKD.
Bookmark/Search this post with
Abstract (Original Language): 
Amaç: Son dönem böbrek yetmezliği hastalarında en genel ölüm sebebi kardiyovasküler hastalıklardır. Asymmetrical dimethylarginine (ADMA) aterosklerozis riskinin artması ile ilişkili durumlarda artmaktadır. Bu çalışmada amaç, kronik böbrek yetmezliği evre 1-3 grubunda, koroner arter darlığı ciddiyeti ile ADMA düzeyleri arasındaki ilişkiyi saptamaktır. GEREÇ ve YÖN TEML ER: Böbrek işlevleri azalmış, klinik koroner arter hastalığı kuşkusu veya kanıtlanmış koroner arter hastalığı ile koroner anjiyografi yapılan 88 hasta çalışmaya alındı. Serum kreatinin, ADMA, nitrik oksit (NO), kalsiyum, fosfat, total kolesterol, HDL, LDL fraksiyonları ve trigliserid düzeyleri ölçüldü. Koroner aterosklerozis ciddiyetini belirlemek için Gensini skorlama sistemi kullanıldı. Bulgular: Ortalama serum düzeyleri ADMA için 81.48±13.8 micromol/l, NO için 3.7±1.7 milimol/L ölçüldü. Bu çalışmada ortalama Gensini skoru olarak 30.4±40.1. saptandı. Tüm hastalar Gensini skoruna göre üç gruba ayrıldı. En yüksek gruptaki hastaların glomerüler filtrasyon hızı (GFR) düzeyleri istatiksel olarak anlamlı derecede düşük saptandı. İlk grupla karşılaştırıldığında üçüncü grupta ADMA düzeyleri anlamlı olarak yüksekti. Tek değişkenli analizde Gensini skoru değerlerinin, ADMA düzeyleri, GFR ve hipertansiyon mevcudiyeti ile uyumlu olduğu saptandı. Çok değişkenli regresyon modelinde, yalnızca ADMA düzeyi Gensini skoru için bağımsız bir belirleyici etken olduğu saptandı. Sonuç: Hafif-orta dereceli kronik böbrek yetmezliği hastalarında, ADMA düzeyleri ateroskleroz için güçlü bir belirteç olarak görülmektedir.
FULL TEXT (PDF): 
PDF icon arastrmx_172977_20_pp_58-64.pdf
  • 1
58-64
  • Turkish

REFERENCES

References: 

1. Stenvinkel P, Alvestrand P: Inflammation in end-stage renal disease:
Sources, consequences and therapy. Seminar Dial 2002; 15: 330-338
2. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM: The elephant
of uremia: Oxidative stress as a unifying concept of cardiovascular
disease in uremia. Kidney Int 2002; 62: 1524-1538
3. Ueda S, Yamagishi S, Matsumoto Y, Fukami K, Okuda S: Asymmetric
dimethylarginine (ADMA) is a novel emerging risk factor for
cardiovascular disease and the development of renal injury in chronic
kidney disease. Clin Exp Nephrol 2007; 11: 115-121
4. Zoccali C, Kielstein JT: Asymmetric dimethylarginine: A new player
in the pathogenesis of renal disease? Curr Opin Nephrol Hypertens
2006; 15: 314-320
5. Vallance P, Leone A, Calver A, Collier J, Moncada S: Accumulation
of an endogenous inhibitor of nitric oxide synthesis in chronic renal
failure. Lancet 1992; 339: 572-575
6. Boger RH, Bode-Boger SM, Szuba A, Tsao PS, Chan JR, Tangphao
O, Blaschke TF, Cooke JP: Asymmetric dimethylarginine
(ADMA): A novel risk factor for endothelial dysfunction: Its role in
hypercholesterolemia. Circulation 1998; 98: 1842-1847
7. Lundman P, Eriksson MJ, Stuhlinger M, Cooke JP, Hamsten A,
Tornvall P: Mild-to-moderate hypertriglyceridemia in young men
is associated with endothelial dysfunction and increased plasma
concentrations of asymmetric dimethylarginine. J Am Coll Cardiol
2001; 38: 111-116
8. Stuhlinger MC, Abbasi F, Chu JW, Lamendola C, McLaughlin
TL, Cooke JP, Reaven GM, Tsao PS: Relationship between insulin
resistance and an endogenous nitric oxide synthase inhibitor. JAMA
2002; 287: 1420-1426
9. Abbasi F, Asagmi T, Cooke JP, Lamendola C, McLaughlin T,
Reaven GM, Stuehlinger M, Tsao PS: Plasma concentrations of
asymmetric dimethylarginine are increased in patients with type 2
diabetes mellitus. Am J Cardiol 2001; 88: 1201-1203
10. Stuhlinger MC, Stanger O: Asymmetric dimethyl-L-arginine
(ADMA): A possible link between homocyst(e)ine and endothelial
dysfunction. Curr Drug Metab 2005; 6: 3-14
11. Surdacki A, Nowicki M, Sandmann J, Tsikas D, Boeger RH, Bode-
Boeger SM, Kruszelnicka-Kwiatkowska O, Kokot F, Dubiel JS,
Froelich JC: Reduced urinary excretion of nitric oxide metabolites
and increased plasma levels of asymmetric dimethylarginine in
men with essential hypertension. J Cardiovasc Pharmacol 1999;
33: 652-658
12. Zoccali C: Asymmetric dimethylarginine (ADMA): A cardiovascular
and renal risk factor on the move. Journal of Hypertension 2006; 24:
611-619
13. Müggea A, Hanefeld C, Böger RH, CARDIAC study investigators:
Plasma concentration of asymmetric dimethylarginine and the risk
of coronary heart disease: Rationale and design of the multicenter
CARDIAC study. Atherosclerosis Supplement 4 2003; 29-32
14. Ganesh SK, Stack AG, Levin N, Hulbert-Shearon T, Port FK:
Association of elevated serum PO4, Ca-PO4 product and parathyroid
hormone with cardiac mortality risk in chronic hemodialysis
patients. J Am Soc Nephrol 2001; 12: 2131-2138
15. Gensini GG: A more meaningful scoring system for determining the
severity of coronary heart disease. Am J Cardiol 1983; 51: 606
16. Schulze F, Wesemann R, Schwedhelm E, Sydow K, Albsmeier J,
Cooke JP, Böger RH: Determination of asymmetric dimethylarginine
(ADMA) using a novel ELISA assay. Clin Chem Lab Med 2004;
42: 1377
17. Cay S, Metin F, Korkmaz S: Association of renal functional
impairment and the severity of coronary artery disease. Anadolu
Kardiyol Derg 2007; 7: 44-48
18. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM: The elephant
of uremia: Oxidative stress as a unifying concept of cardiovascular
disease in uremia. Kidney Int 2002; 62: 1524-1538
19. Gradaus F, Ivens K, Peters AJ, Heering P, Schoebel FC, Grabense
B, Strauer BE: Angiographic progression of coronary artery disease
in patients with end-stage renal disease. Nephrol Dial Transplant
2001; 16: 1198-1202
20. Matsushita K, Selvin E, Bash LD, Franceschini N, Astor BC, Coresh
J: Change in Estimated GFR Associates with Coronary Heart Disease
and Mortality. J Am Soc Nephrol 2009; 20: 2617-2624
21. Ganesh SK, Stack AG, Levin N, Hulbert-Shearon T, Port FK:
Association of elevated serum PO4, Ca-PO4 product and parathyroid
hormone with cardiac mortality risk in chronic hemodialysis
patients. J Am Soc Nephrol 2001; 12: 2131-2138
22. Miyazaki H, Matsuoka H, Cooke JP, Usui M, Ueda S, Okuda S,
Imaizumi T: Endogenous nitric oxide synthase inhibitor: A novel
marker of atherosclerosis. Circulation 1999; 99: 1141-1146
23. Zoccali C, Benedetto FA, Maas R, Mallamaci F, Tripepi G, Malatino
LS, Böger R, CREED Investigators: Asymmetric dimethylarginine,
C-reactive protein, and carotid intima-media thickness in end-stage
renal disease. J Am Soc Nephrol 2002; 13: 490-496
24. Ravani P, Tripepi G, Malberti F, Testa S, Mallamaci F, Zoccali C:
Asymmetrical dimethylarginine predicts progression to dialysis and
death in patients with chronic kidney disease: A competing risks
modeling approach. J Am Soc Nephrol 2005; 16: 2449-2455
25. Yilmaz MI, Eyileten T, Yenicesu M: Kronik böbrek hastalığında
yeni bir oyuncu: Asimetrik dimetilarginin (ADMA). Turk Neph
Dial Transpl 2007; 16(3): 93-101

Thank you for copying data from http://www.arastirmax.com