Key result
Serum ADMA levels were significantly higher in maintenance dialysis patients compared to healthy controls (0.64 vs. 0.42 nmol/mL, p<0.001) and were significantly reduced by hemodialysis therapy.
Why the study?
Are serum asymmetric dimethylarginine (ADMA) levels elevated in Japanese maintenance dialysis patients compared to healthy controls, and is ADMA reduced by hemodialysis?
Cross-Sectional (n=105)
No
Are serum asymmetric dimethylarginine (ADMA) levels elevated in Japanese maintenance dialysis patients compared to healthy controls, and is ADMA reduced by hemodialysis?
Serum ADMA, an endogenous NOS inhibitor linked to cardiovascular disease, is elevated in Japanese maintenance dialysis patients and can be partially cleared by hemodialysis, suggesting impaired degradation contributes to its accumulation.
Answers are grounded in this paper and cite their sources.
Elevated ADMA may mark CVD risk in dialysis patients; leaves open whether reduction improves outcomes.
NO合成を阻害する内因性のNO合成酵素 (NOS) 阻害物質asymmetric dimethylarginine (ADMA) の維持透析患者における血中動態について検討した. 対象は96名で, 血液透析 (HD) 患者72名, 腹膜透析 (PD) 患者24名. 44例はHD後にもADMAを測定した. 健常者9名を対照群とした. 維持透析患者の血清ADMAは0.64±0.13nmol/mLで対照群0.42±0.06nmol/mLにくらべ有意に高値であった (p<0.001). HD患者のHD前値は0.67±0.12nmol/mLでありPD患者0.56±0.11nmol/mLにくらべ有意に高値であった (p<0.01). しかしADMAのHD前血清濃度は, 同時に測定したBUNやCrと相関を認めなかった. また, 1回の血液透析でのADMA血清濃度低下率は42.6±13.9%で, BUN, Crの低下率とくらべると有意に低く (vs. BUN, vs. Cr: p<0.0001), ADMAとBUN, Crの濃度低下率の間にはそれぞれ有意の正相関を認めた (vs. BUN: r=0.732, p<0.0001, vs. Cr: r=0,755, p<0.0001).以上より, 本邦人の透析患者でも欧米人と同様に透析前血清ADMA濃度は健常者より高値であり, 一回の血液透析によりBUNやCrの除去率と高い相関性をもって除去される. しかし透析前血清ADMA濃度上昇機序はBUNやCrとは異なり, 体内での産生亢進または腎臓以外の組織・臓器での分解低下が関与していることが示唆された.
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Iwaswa et al. (2006) conducted a cross-sectional in End-stage renal disease on maintenance dialysis (n=105). Maintenance dialysis vs. Healthy subjects was evaluated on Serum ADMA level (nmol/mL) (p=<0.001). Serum ADMA levels were significantly higher in maintenance dialysis patients compared to healthy controls (0.64 vs. 0.42 nmol/mL, p<0.001) and were significantly reduced by hemodialysis therapy.
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