Sp560impact of Endothelin-1 (Et-1), Transforming Growth Factor-Beta (Tgf-Beta), Platelet-Derived Growth Factor (Pdgf) and Asymmetric Dimethylarginine (Adma) on Cardiovascular Mortality Among Hemodialysis Patients-a Longitudinal Study

INTRODUCTION: Series of cytokines that promote inflammation, angiogenesis, proliferation and atherosclerosis are elevated in serum of hemodialysis patients. The aim of this study was to analyze influence of serum concentrations of Transforming growth factor-beta (TGF-β), Endothelin-1 (ET1), Platelet-derived growth factor (PDGF) and Asymmetric dimethylarginine (ADMA) on cardiovascular (CV) mortality in hemodialysis patients. METHODS: In April 2015th, serum concentrations of ET-1, PDGF, TGF-beta and ADMA were measured in 176 hemodialysis patients before midweekly dialysis session. They were followed until death or end of the study (January 1st 2019th). We compared deceased patients from CV reason (No=33) and survivors (No=108) and excluded 35 patients deceased from non-CV death. Analyses included demographic, clinical and laboratory data. RESULTS: Compared to survivors, deceased patients were significantly older, had lower Kt/V values, were less frequently on hemodiafiltration, had more comorbidities including PVD. They exhibited lower serum albumin, cholesterol, triglyceride and hemoglobinlevels. ADMA and TGF-beta (but not PDGF and ET-1) levels were higher in deceased patients compared to survivors. For survival analysis, patients were divided into different ADMA level groups according to quartiles (Q) since the great difference in mean values between groups were found in ADMA levels. Mean survival was 39 ± 12 (Q1), 38 ± 12 (Q2), 38 ± 14 (Q3) and 33 ± 15 months (Q4), p = 0.399 (Picture 1). Cox multivariate regression analysis showed that independent predictors for all-cause mortality were albumin levels and age. Although without statistical significance, ADMA in the range of Q3 and Q4 increased 1.7 and 1.6 foldrisk for CV death respectively. CONCLUSIONS: Among different causes of CV Mb and Mt, higher plasma level of AMDA as a surrogate marker may be associated with CV outcome in HD population. Better nutritional status and dialysis quality may improve survival among dialysis patients.