Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2008, vol. 17, nr 2, March-April, p. 191–196

Publication type: original article

Language: English

Elevated ADMA Levels Are an Early Event in Chronic Hemodialysis Patients

Podwyższone stężenie ADMA wczesnym zjawiskiem w czasie leczenia hemodializami

Robert Krawczyk1,2,, Wacław Weyde1,, Magdalena Krajewska1,, Katarzyna Madziarska1,, Alicja Piasecka−Grzeszek3,, Urszula Solska3,, Marian Klinger2,

1 Department of Nephrology and Transplantation Medicine, Silesian Piasts University of Medicine in Wrocław, Poland

2 International Dialysis Center, Ostrów Wlkp., Poland

3 Department of Internal Medicine, Occupational Diseases and Hypertension, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Background. Elevated ADMA concentration appears as a novel cardiovascular risk factor in chronic HD patients. However, no data exist in the literature on a potential relationship between ADMA levels and duration of maintenance HD treatment.
Objectives. The aim of this study was to analyze the connections between ADMA levels and the period of chronic hemodialysis treatment (HD), the efficiency of the procedure, severity of hypertension, intensity of inflammatory reaction, and nutritional indices.
Material and Methods. The study was performed on 37 healthy volunteers (18 female and 19 male, mean age: 48.1 ± 11.3 years) and in two groups of chronic HD patients: 68 patients on maintenance HD for 6–24 months (31 female and 37 male, age: 52.4 ± 10.3 years) and 24 patients on HD for over 60 months (10 female and 14 male, age: 56.8 ± 10.3 years). The ADMA and L−arginine concentrations were measured by the HPLC method.
Results. ADMA serum levels were significantly elevated in the HD patients independent of the duration of maintenance HD treatment. ADMA concentrations in the HD patients were also not affected by age, smoking habit, or the class of antihypertensive drugs. A paradoxical positive correlation between serum albumin and ADMA concentration appeared in the HD patients treated for less than two years. This can be explained by the fact that higher protein intake supports ADMA generation. Significant correlation was found between ADMA and total serum cholesterol only in the patients on HD for over five years. In addition, elevated L−arginine occurred in well−nourished HD patients, possibly due to inhibition of the degradation process.
Conclusion. The duration of maintenance HD treatment, age, smoking habit, and class of antihypertensive drugs do not exert an impact on elevated ADMA concentration. In adequately nourished HD patients, a deficiency of L−arginine (substrate for nitric oxide synthesis) does not occur.

Streszczenie

Wprowadzenie. Podwyższone stężenie ADMA uznaje się za nowy czynnik zagrożenia sercowo−naczyniowego u przewlekle dializowanych chorych. W piśmiennictwie nie ma jednak danych na temat zależności między stężeniem ADMA a długotrwałością leczenia dializami.
Cel pracy. Analiza powiązań między stężeniem ADMA a długością okresu dializoterapii, skutecznością zabiegów hemodializy, ciężkością nadciśnienia, nasileniem procesu zapalnego i stanem odżywienia.
Materiał i metody. Badania zostały przeprowadzone u 37 zdrowych ochotników (18 kobiet i 19 mężczyzn w wieku 48.1 ± 11.3 roku) i w 2 grupach przewlekle hemodializowanych chorych: a) 68 chorych leczonych dializami 6–24 miesiące (31 kobiet i 37 mężczyzn w wieku 52.4 ± 10.3 roku) oraz b) 24 chorych leczonych hemodializami powyżej 60 miesięcy (10 kobiet i 14 mężczyzn w wieku 56.8 ± 10.3 roku). Stężenia ADMA i L−argininy oznaczono metodą HPLC.
Wyniki. Stężenia ADMA były istotnie większe w obu grupach hemodializowanych chorych. Na ich wartości nie miały również wpływu: wiek chorych, palenie papierosów oraz rodzaj przyjmowanych leków hipotensyjnych. Zaskakująca, dodatnia korelacja między zawartością albumin i stężeniem ADMA w surowicy, pojawiająca się w grupie chorych będących w programie hemodializ mniej niż 2 lata, może być wytłumaczona zwiększonym wytwarzaniem ADMA u chorych spożywających dietę z większą zawartością białka. Istotna korelacja między stężeniami ADMAi cholesterolu ujawniła się tylko u chorych leczonych hemodializami powyżej 5 lat. U dobrze odżywionych przewlekle hemodializowanych wykryto ponadto zwiększenie stężeń L−argininy, prawdopodobnie na skutek zahamowania procesu jej rozkładu.
Wnioski. Długotrwałość okresu dializoterapii, wiek, nikotynizm oraz rodzaj leczenia hipotensyjnego nie wywierają wpływu na zwiększone stężenie ADMA. U prawidłowo odżywionych, przewlekle dializowanych chorych nie występuje niedobór L−argininy, substratu do syntezy tlenku azotu.

Key words

ADMA, L−arginine concentrations, HD patients, period of maintenance HD, hypertension, CRP, albumin, cholesterol levels

Słowa kluczowe

ADMA, stężenie L−argininy, pacjenci leczeni hemodializami, czas leczenia hemodializami, nadciśnienie, CRP, albumina, stężenie cholesterolu

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