Plasma Concentration of Asymmetric Dimethylarginine (ADMA) Predicts Cardiovascular Morbidity and Mortality in Type 1 Diabetic Patients With Diabetic Nephropathy  

Oleh:

Lajer, Maria ; Tarnow, Lise ; Jorsal, Anders ; Teerlink, Tom ; Parving, Hans-Henrik ; Rossing, Peter

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 31 no. 04 (Apr. 2008), page 747.
Topik: ADMA; asymmetric dimethylarginine ; AHT; antihypertensive treatment ; CVD; cardiovascular disease ; DDAH; dimethylarginine dimethylaminohydrolases ; ESRD; end-stage renal disease ; GFR; glomerular filtration rate ; SDC; Steno Diabetes Center ; SDMA; symmetrical dimethylarginine

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K.2008.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

OBJECTIVE—To investigate whether circulating asymmetric dimethylarginine (ADMA) levels are predictive of cardiovascular events, decline in glomerular filtration rate (GFR), end-stage renal disease (ESRD), and all-cause mortality in type 1 diabetic patients. RESEARCH DESIGN AND METHODS—We performed a prospective observational follow-up study including 397 type 1 diabetic patients with overt diabetic nephropathy (243 men aged 42.1 ± 10.5 years, GFR 76 ± 34 ml/min per 1.73 m2) and a control group of 175 patients with longstanding type 1 diabetes and persistent normoalbuminuria (104 men aged 42.7 ± 9.7 years, duration of diabetes 27.7 ± 8.3 years). Patients were followed for a median 11.3 years (range 0.0–12.9) with yearly measurements of GFR (51Cr-EDTA plasma clearance) in patients with diabetic nephropathy. Endpoints were fatal and nonfatal cardiovascular disease (CVD), decline in GFR, ESRD, and all-cause mortality. RESULTS—Among patients with diabetic nephropathy, 37 patients (19.4%) with ADMA levels below the median, compared with 79 patients (43.4%) above the median, suffered a major cardiovascular event during the follow-up period (P < 0.001). This effect persisted after adjustment for conventional CVD risk factors including baseline GFR (adjusted hazard ratio [HR] for elevated ADMA 2.05 [95% CI 1.31–3.20], P = 0.002). Furthermore, elevated ADMA levels predicted an increased rate of decline in GFR, development of ESRD, and all-cause mortality (P < 0.001). After adjustment for well-known progression promoters, including baseline GFR, the HR (adjusted) was 1.85 (95% CI 0.99–3.46, P = 0.055) for ESRD comparing upper and lower median ADMA levels. CONCLUSIONS—Plasma ADMA levels predict fatal and nonfatal cardiovascular events in patients with type 1 diabetic nephropathy. Furthermore, increased ADMA levels tend to contribute to increased risk of progressive diabetic kidney disease.

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