Advanced chronic kidney disease populations have elevated trimethylamine N-oxide levels associated with increased cardiovascular events | Zendy

Richard B. Kim | Zendy; Bridget L. Morse | Zendy; Ognjenka Djurdjev | Zendy; Mila Tang | Zendy; Norman Muirhead | Zendy; Brendan J. Barrett | Zendy; Daniel T. Holmes | Zendy; François Madore | Zendy; Catherine M. Clase | Zendy; Claudio Rigatto | Zendy; Adeera Levin | Zendy; Mohsen Agharazii | Zendy; Joanne Blouin | Zendy; France Samson | Zendy; Ayub Akbarii | Zendy; Judy O. Cheesman | Zendy; Jennilea Courtney | Zendy; Sabrina Hamer | Zendy; Edita Delic | Zendy; Valerie Cronin | Zendy; Paul E. Barré | Zendy; Jeffrey A. Golden | Zendy; Elizabeth Langille | Zendy; Sylvia Adams | Zendy; Janet Morgan | Zendy; Cathy Moreau | Zendy; Susan M. Cooper | Zendy; Brian Forzley | Zendy; Susan Caron | Zendy; Shauna Granger | Zendy; Susan Valley | Zendy; Helen Sather | Zendy; Serge Cournoyer | Zendy; Lorraine Ménard | Zendy; Michèle Roy | Zendy; Hélène Skidmore | Zendy; Dolores Beaudry | Zendy; Janis M. Dionne | Zendy; Josephine Chow | Zendy; Valla Sahraei | Zendy; Sandra Donnelly | Zendy; Niki Dacouris | Zendy; Rosa M. Marticorena | Zendy; Brenda R. Hemmelgarn | Zendy; Sharon Gulewich | Zendy; Troy Hamilton | Zendy; Paul Keown | Zendy; Nadia Zalunardo | Zendy; Daniel A. Rogers | Zendy; Reena Tut | Zendy; M. Paquette | Zendy; Rossitta Yung | Zendy; Nancy Ferguson | Zendy; Helen Chiu | Zendy; Kathleen Carlson | Zendy; Lina Sioson | Zendy; Taylor Perry | Zendy; Zainab Sheriff | Zendy; Naama Rozen | Zendy; Charmaine E. Lok | Zendy; Michelle Cross | Zendy; Cathy Forrester | Zendy; Alexandra Cotoi | Zendy; Ma Maltais | Zendy; Louise Moist | Zendy; Kerri Gallo | Zendy; Sarah Langford | Zendy; Leah Slamen | Zendy; Danielle Cram | Zendy; Mary Jeanne Edgar | Zendy; Taylor Gray | Zendy; Cameron Edgar | Zendy; Karen E. GROENEWEG | Zendy; Eileen M. McKin | Zendy; Erin McRae | Zendy; Kyla Blackie | Zendy; Bharat Nathoo | Zendy; Kimmy Lau | Zendy; Malvinder S. Parmar | Zendy; Sylvie Gélinas | Zendy; Martine Leblanc | Zendy; Lucie Lépine | Zendy; Dolores Friesen | Zendy; Steven D. Soroka | Zendy; Susan Fleet | Zendy; Jeanette Squires | Zendy; Siva Thanamayooran | Zendy; Michael Binder | Zendy; Christine Hines | Zendy; Brenda McNeil | Zendy; Patrice McDougall | Zendy; Howard Joy | Zendy; Deborah Gillis | Zendy; Kathleen Hines | Zendy; Sheldon W. Tobe | Zendy; Mary Chessman | Zendy; Nancy Perkins | Zendy; Martha Agelopoulos | Zendy; Stacey Knox | Zendy; Tiffany Richards | Zendy; Marcello Tonelli | Zendy; Susan K. Szigety | Zendy; Dawn Opgenorth | Zendy; Karen Yeates | Zendy; Karen Mahoney | Zendy

Open Access

Advanced chronic kidney disease populations have elevated trimethylamine N-oxide levels associated with increased cardiovascular events

Author(s) -

Richard B. Kim,

Bridget L. Morse,

Ognjenka Djurdjev,

Mila Tang,

Norman Muirhead,

Brendan J. Barrett,

Daniel T. Holmes,

François Madore,

Catherine M. Clase,

Claudio Rigatto,

Adeera Levin,

Mohsen Agharazii,

Joanne Blouin,

France Samson,

Ayub Akbarii,

Judy O. Cheesman,

Jennilea Courtney,

Sabrina Hamer,

Edita Delic,

Valerie Cronin,

Paul E. Barré,

Jeffrey A. Golden,

Elizabeth Langille,

Sylvia Adams,

Janet Morgan,

Cathy Moreau,

Susan M. Cooper,

Brian Forzley,

Susan Caron,

Shauna Granger,

Susan Valley,

Helen Sather,

Serge Cournoyer,

Lorraine Ménard,

Michèle Roy,

Hélène Skidmore,

Dolores Beaudry,

Janis M. Dionne,

Josephine Chow,

Valla Sahraei,

Sandra Donnelly,

Niki Dacouris,

Rosa M. Marticorena,

Brenda R. Hemmelgarn,

Sharon Gulewich,

Troy Hamilton,

Paul Keown,

Nadia Zalunardo,

Daniel A. Rogers,

Reena Tut,

M. Paquette,

Rossitta Yung,

Nancy Ferguson,

Helen Chiu,

Kathleen Carlson,

Lina Sioson,

Taylor Perry,

Zainab Sheriff,

Naama Rozen,

Charmaine E. Lok,

Michelle Cross,

Cathy Forrester,

Alexandra Cotoi,

Ma Maltais,

Louise Moist,

Kerri Gallo,

Sarah Langford,

Leah Slamen,

Danielle Cram,

Mary Jeanne Edgar,

Taylor Gray,

Cameron Edgar,

Karen E. GROENEWEG,

Eileen M. McKin,

Erin McRae,

Kyla Blackie,

Bharat Nathoo,

Kimmy Lau,

Malvinder S. Parmar,

Sylvie Gélinas,

Martine Leblanc,

Lucie Lépine,

Dolores Friesen,

Steven D. Soroka,

Susan Fleet,

Jeanette Squires,

Siva Thanamayooran,

Michael Binder,

Christine Hines,

Brenda McNeil,

Patrice McDougall,

Howard Joy,

Deborah Gillis,

Kathleen Hines,

Sheldon W. Tobe,

Mary Chessman,

Nancy Perkins,

Martha Agelopoulos,

Stacey Knox,

Tiffany Richards,

Marcello Tonelli,

Susan K. Szigety,

Dawn Opgenorth,

Karen Yeates,

Karen Mahoney

Publication year - 2016

Publication title -

kidney international

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 3.499

H-Index - 276

eISSN - 1523-1755

pISSN - 0085-2538

DOI - 10.1016/j.kint.2016.01.014

Subject(s) - trimethylamine n oxide , hazard ratio , interquartile range , kidney disease , medicine , confidence interval , renal function , prospective cohort study , quartile , risk factor , gastroenterology , endocrinology , trimethylamine , biology , biochemistry

Cardiovascular disease is more common in patients with chronic kidney disease (CKD), and traditional risk factors do not adequately predict those at risk for cardiovascular (CV) events. Recent evidence suggests elevated trimethylamine N-oxide (TMAO), created by gut microflora from dietary L-carnitine and choline, is associated with CV events. We investigated the relationship of TMAO levels in patients with stages 3b and 4 CKD to ischemic CV events using the CanPREDDICT cohort, a Canada-wide observational study with prospective 3-year follow-up of adjudicated CV events. Baseline samples were obtained for 2529 CKD patients. TMAO, choline, and L-carnitine levels were measured using tandem mass spectrometry. Baseline median TMAO level was high for the whole cohort (20.41 μM; interquartile range [IQR]: 12.82-32.70 μM). TMAO was independently associated with CV events (hazard ratio 1.23; 95% confidence interval: 1.06-1.42 / 1 SD lnTMAO) after adjusting for all potential CV risk factors. Those in the highest TMAO quartile had significantly higher risk of CV events (adjusted hazard ratio 1.59; 95% confidence interval: 1.04-2.43; P = 0.0351) in the analysis of recurring ischemic events. Among those with stage 3b CKD (hazard ratio 1.45; 95% confidence interval: 1.12-1.87 / 1 SD lnTMAO), independent of kidney function, TMAO levels identified those at highest risk for events. Our results suggest that TMAO may represent a new potentially modifiable CV risk factor for CKD patients. Further studies are needed to determine sources of variability and if lowering of TMAO reduces CV risk in CKD.

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