Document Detail


Plasma ADMA predicts restenosis of arteriovenous fistula.
MedLine Citation:
PMID:  19118151     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Plasma levels of asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide production, correlate with endothelial dysfunction and the development of cardiovascular events in patients with uremia. It is not known whether endothelial dysfunction contributes to the dysfunction of arteriovenous fistulas (AVFs) in hemodialysis patients. Here, we studied the predictive value of baseline plasma ADMA for symptomatic restenosis of an AVF after percutaneous transluminal angioplasty in dialysis patients. We obtained baseline plasma ADMA levels before percutaneous transluminal angioplasty in 100 consecutive patients with dysfunctional AVFs. Patients were followed up clinically for up to 6 mo after angioplasty for recurrent dysfunction. During the 6 mo after angioplasty, 46 patients experienced recurrent dysfunction of their AVF; of these, follow-up fistulography showed restenosis at the same location in 41, new stenosis at different locations in two, and no significant stenosis in three patients. Up to 60% of the patients with high levels of ADMA (>0.910 microM) had target lesion restenosis compared with 25% of those with low levels (<0.910 microM; P < 0.001). In multivariate analysis, plasma ADMA independently nearly tripled the risk for recurrent symptomatic stenosis of an AVF after percutaneous transluminal angioplasty (hazard ratio 2.65; 95% confidence interval 1.33 to 5.28). These results suggest a role for ADMA in the progression of symptomatic restenoses of AVFs after percutaneous transluminal angioplasty and call for preventive strategies that target ADMA and/or endothelial dysfunction to decrease the risk for AVF restenosis.
Authors:
Chih-Cheng Wu; Szu-Chi Wen; Chung-Wei Yang; Shih-Yun Pu; Kuei-Chin Tsai; Jaw-Wen Chen
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-12-31
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  20     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-08     Completed Date:  2009-01-23     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-22     Citation Subset:  IM    
Affiliation:
Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Taipei, Taiwan, Republic of China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Balloon*
Arginine / analogs & derivatives*,  blood
Arteriovenous Shunt, Surgical / adverse effects*
C-Reactive Protein / analysis
Constriction, Pathologic
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Renal Dialysis*
Risk Factors
Chemical
Reg. No./Substance:
30315-93-6/N,N-dimethylarginine; 74-79-3/Arginine; 9007-41-4/C-Reactive Protein
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