Relationship between serum asymmetric dimethylarginine and left ventricular structure and function in patients with end‑stage renal disease treated with hemodialysis

INTRODUCTION Asymmetric dimethylarginin (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase, considered an effector of endothelial dysfunction. Among multiple diseases associated with elevated ADMA, chronic renal disease is often mentioned. ADMA is thought to be related to certain adverse cardiovascular effects of chronic uremia. The association between left ventricular (LV) structure and function and ADMA has been studied in numerous papers, but only few of them addressed this issue in end‑stage renal disease (ESRD).
OBJECTIVES The aim of the study was to analyze associations between serum ADMA (sADMA) levels and LV geometry and function in patients with ESRD treated with hemodialysis (HD).
PATIENTS AND METHODS The study group included 56 patients (31 women, 25 men) aged 59.0 ±13.1 years, treated with HD for 70 ±67 months. sADMA and biochemical parameters were measured and echocardiography was performed. sADMA levels were also measured in the control group of healthy individuals matched for age. 
RESULTS Mean sADMA levels in patients were 2.39 ±1.0 μmol/ and were significantly higher compared with controls (0.55 ±0.12 μmol/l; P <0.01). Based on echocardiography, patients were classified into the following groups: normal LV geometry (17.8%), concentric remodeling (8.9%), concentric hypertrophy (35.7%), excentric hypertrophy (37.5%), impaired systolic function (10.7%), and impaired diastolic function (71.4%) (1 patient could be in 1 or more groups). sADMA correlated with mean (r = 0.78; P <0.05) and relative (r = 0.64; P <0.05) LV wall thickness and with the LV mass index (r = 0.65; P <0.05), but not with the indexes of systolic and diastolic function. sADMA was significantly higher in patients with excentric hypertrophy, concentric remodeling, and concentric hypertrophy compared with patients with normal LV geometry, and the highest was in patients with concentric hypertrophy.
CONCLUSIONS Our study demonstrated an association between sADMA and disturbances in LV geometry in patients with ESRD treated with HD.