Circulating levels of asymmetric dimethylarginine are an independent risk factor for left ventricular hypertrophy and predict cardiovascular events in pre-dialysis patients with chronic kidney disease

BackgroundSeveral studies have related the circulating level of asymmetric dimethylarginine (ADMA) to cardiac remodeling and cardiovascular (CV) events in end-stage renal disease (ESRD) patients. Studies investigating this relationship in patients with pre-dialysis chronic kidney disease (CKD) are lacking.MethodsWe enrolled 76 CKD patients (age, 46.7 ± 14.3 years, 39 females) and 15 controls (age, 40.1 ± 18.5 years, 6 females). Clinical parameters, blood biochemistry and echocardiographic findings were recorded, and plasma ADMA concentrations measured by high-performance liquid chromatography–mass spectrometry (HPLC–MS). Patients were prospectively followed up for a median of 15 (range, 6–24) months.ResultsPlasma ADMA was significantly elevated in CKD patients compared with controls (41.56 ± 12.76 μg/mL vs 17.12 ± 7.09 μg/mL, P < 0.001), and correlated with the left ventricular mass index (LVMI) (r = 0.597, P < 0.001). During follow-up, 25 patients experienced new CV events and their plasma ADMA level was significantly elevated (48.27 ± 13.70 vs 34.91 ± 6.38 in CV event-free patients, P < 0.001). Cox regression analysis further confirmed that ADMA was an independent risk factor for CVD (HR = 1.175, 95%CI[1.070–1.290], P = 0.001).ConclusionSimilar to findings in ESRD patients, elevated circulating levels of ADMA may increase the risk of LVH and CV events in pre-dialysis CKD patients.