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Asymmetric Dimethylarginine in Hemodialysis, Hemodiafiltration, and Peritoneal Dialysis
Author(s) -
Eiselt Jaromír,
Rajdl Daniel,
Racek Jaroslav,
Široká Romana,
Trefil Ladislav,
Opatrná Sylvie
Publication year - 2010
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2009.00872.x
Subject(s) - asymmetric dimethylarginine , medicine , peritoneal dialysis , homocysteine , hemodialysis , endothelial dysfunction , oxidative stress , glycation , endocrinology , renal replacement therapy , renal function , nitric oxide , dialysis , diabetes mellitus , gastroenterology , urology , arginine , chemistry , biochemistry , amino acid
Asymmetric dimethylarginine (ADMA) is a mediator of endothelial dysfunction. Production and elimination of ADMA may be affected by the type of renal replacement therapy used and oxidative stress. Plasma ADMA, advanced glycation end products (AGE), and homocysteine were assessed in 59 subjects: 20 hemodialysis (HD) patients, 19 patients undergoing peritoneal dialysis (PD), and 20 controls. Results were compared between the groups. The effect of 8 weeks of HD and high‐volume predilution hemodiafiltration (HDF) was compared in a randomized study. HD patients showed higher ADMA (1.20 [0.90–1.39 µmol/L]) compared to controls (0.89 [0.77–0.98], P < 0.01), while ADMA in PD did not differ from controls (0.96 [0.88–1.28]). AGE and homocysteine were highest in HD, lower in PD ( P < 0.01 vs. HD), and lowest in controls ( P < 0.001 vs. HD and PD). PD patients had higher residual renal function than HD ( P < 0.01). The decrease in ADMA at the end of HD (from 1.25 [0.97–1.33] to 0.66 [0.57–0.73], P < 0.001) was comparable to that of HDF. Switching from HD to HDF led to a decrease in predialysis homocysteine level in 8 weeks ( P < 0.05), while ADMA and AGE did not change. Increased ADMA levels in patients undergoing HD, as compared to PD, may be caused by higher oxidative stress and lower residual renal function in HD. Other factors, such as diabetes and statin therapy, may also be at play. The decrease in ADMA at the end of HD and HDF is comparable. Switching from HD to HDF decreases in 8 weeks the predialysis levels of homocysteine without affecting ADMA.