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

OBJECTIVE: 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.

MATERIAL and METHODS: 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.

RESULTS: 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.

CONCLUSION: ADMA appears to be one of the strongest risk markers for atherosclerosis in patients with mild and moderate CKD.