Asymmetrical Dimethylarginine Is Associated with Renal and Cardiovascular Outcomes and All-cause Mortality in Renal Transplant Recipients
Abedini S, Meinitzer A, Holme I, März W, Weihrauch G, Fellstrøm B, Jardine A, Holdaas H. Kidney Int. 2010 Jan;77(1):44-50
ADMA is a known risk factor for mortality and cardiovascular events in the CKD and ESRD populations. This study found that transplant recipients with higher levels of ADMA were at an increased risk of graft failure, cardiovascular events and death. Whether therapeutic interventions that lower ADMA levels would decrease the risk of death is unknown.
Related Articles:
- Troponin I is a Predictor of Acute Cardiac Events in the Immediate Postoperative Renal Transplant Period
- Interleukin-2 Receptor Antibody Reduces Rejection Rates and Graft Loss in Live-Donor Kidney Transplant Recipients
- Cigarette Smoking, Kidney Function, and Mortality After Live Donor Kidney Transplant
Abstract:
Increased plasma levels of asymmetric dimethylarginine (ADMA) are associated with endothelial dysfunction and predict the progression to dialysis and death in patients with chronic kidney disease. The effects of these increased ADMA levels in renal transplant recipients, however, are unknown. We used the data from ALERT, a randomized, double-blind, placebo-controlled study of the effect of fluvastatin on cardiovascular and renal outcomes in 2102 renal transplant recipients with stable graft function on enrollment. Patients who were initially randomized to fluvastatin or placebo in the 5- to 6-year trial were offered open-label fluvastatin in a 2-year extension of the original study. After adjustment for baseline values for established factors in this post hoc analysis, ADMA was found to be a significant risk factor for graft failure or doubling of serum creatinine (hazard ratio 2.78), major cardiac events (hazard ratio 2.61), cerebrovascular events (hazard ratio 6.63), and all-cause mortality (hazard ratio 4.87). In this trial extension, the number of end points increased with increasing quartiles of plasma ADMA levels. All end points were significantly increased in the fourth compared to the first quartile. Our study shows that elevated plasma levels of ADMA are associated with increased morbidity, mortality, and the deterioration of graft function in renal transplant recipients.
Recent Comments