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J Am Soc Nephrol 10:594-600, 1999
© 1999 American Society of Nephrology

REGULAR ARTICLES

Asymmetric Dimethylarginine Plasma Concentrations Differ in Patients with End-Stage Renal Disease

Relationship to Treatment Method andAtherosclerotic Disease

JAN T. KIELSTEIN*, RAINER H. BÖGER{dagger}, STEFANINE M. BODE-BÖGER{dagger}, JÜRGEN SCHÄFFER*, MARK BARBEY{ddagger}, KARL M. KOCH* and JÜRGEN C. FRÖLICH{dagger}

* Department of Nephrology, Hannover Medical School, Hannover, Germany.
{dagger} Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.
{ddagger} Department of Diagnostic Radiology, Hannover Medical School, Hannover, Germany.

Correspondence to Dr. Rainer H. Böger, Institute of Clinical Pharmacology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Phone: 49 511 532 4631; Fax: 49 511 532 5199; E-mail: boeger.rainer {at}mh-hannover.de

Abstract. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide (NO) synthase. Its concentration is elevated in patients with end-stage renal disease (ESRD), in part because it is excreted via the kidneys. In this study, the plasma concentrations of ADMA, symmetric dimethylarginine, and L-arginine were determined in relation to plasma nitrate levels (as an index of NO formation) for a group of 80 patients with ESRD. The effects of two treatment methods, i.e., hemodialysis (HD) and peritoneal dialysis (PD), and the role of the presence of atherosclerotic disease were evaluated. Forty-three patients receiving HD and 37 patients receiving PD were compared with healthy control subjects. Plasma L-arginine and dimethylarginine levels were determined by HPLC, using precolumn derivatization with o-phthaldialdehyde. Plasma nitrate levels were determined by gas chromatography-mass spectrometry. Predialysis ADMA concentrations in HD-treated patients were approximately sixfold higher than those in the control group (6.0 ± 0.5 versus 1.0 ± 0.1 µmol/L; P < 0.05). Plasma nitrate concentrations were significantly lower in HD-treated patients, which suggests that ADMA may inhibit NO synthase. In contrast, plasma ADMA levels and nitrate concentrations in PD-treated patients were similar to those in control subjects. Plasma L-arginine concentrations were not significantly decreased in patients with ESRD. ADMA concentrations were significantly decreased 5 h after HD, compared with baseline values. ADMA levels were significantly higher in HD-treated patients with manifest atherosclerotic disease than in HD-treated patients without atherosclerotic disease (7.31 ± 0.70 versus 3.95 ± 0.52 µmol/L; P < 0.05). This study confirms that ADMA is accumulated in ESRD. PD-treated patients exhibit significantly lower ADMA levels than do HD-treated patients. Accumulation of ADMA may be a risk factor for the development of endothelial dysfunction and cardiovascular disease in patients with ESRD.




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