ADMA in chronic renal failure and hemodialysis treatment
Patients with chronic renal failure were the first group of patients in whom elevated ADMA levels were shown to be present (Figure 13). Meanwhile, this finding has been confirmed in numerous studies [23].
| Figure 13. ADMA plasma levels in hemodialysis patients with or without concomitant cardiovascular disease. (Data from [28]). |
The elevation of ADMA levels in patients with end-stage renal failure is partly caused by deficient elimination of ADMA during hemodialysis [28]. Elevated ADMA levels contribute to endothelial dysfunction present in this disease; they may in part be responsible for the highly elevated cardiovascular morbidity and mortality in chronic renal failure [23].
Determination of ADMA allows to draw prognostic conclusions in this patient group: In a prospective clinical study involving 224 patients undergoing regular hemodialysis treatment, patients whose ADMA levels initially were in the highest quartile had the highest total mortality and the highest rate of major cardiovascular events during 3 years of follow-up. As an example, total mortality during 33 months of follow-up was 72% higher in patients with ADMA above the median (2.52 µmol/l), and by more than two-fold in patients with ADMA levels above the 75th percentile (3.85 µmol/l) (Figure 14) [29].
| Figure 14. Total mortality of hemodialysis patients during almost three years of follow-up in relationship to their initial ADMA plasma levels. Patients with elevated ADMA have an increased probability of dying of any cause (Data from [29]). |
Despite the high elevation of ADMA levels in patients with chronic renal failure as compared to healthy subjects, quantification of ADMA allows to further differentiate between renal failure patients with high or low cardiovascular risk, and therapeutic consequences may accordingly be drawn from this information.
