Level of Asymmetric Dimethylarginine (ADMA) in  Children with End Stage Renal Disease (ESRD) on  Regular Hemodialysis

Abdel Malak CA; Fadel FI; Moussa TE; Badr AM; Al Ramlawy AM

Volume : IV, Issue : II, February - 2014

Level of Asymmetric Dimethylarginine (ADMA) in Children with End Stage Renal Disease (ESRD) on Regular Hemodialysis

Abdel Malak Ca , Fadel Fi , Moussa Te, Badr Am, Al Ramlawy Am

Abstract :

Background: Asymmetric dimethylarginine (ADMA) is an endogenous amino acid similar to L-arginine and able to inhibit the enzyme endothelial nitric oxide synthase (eNOS). It is a factor of impaired nitric oxide (NO) synthesis. Serum levels of ADMA in chronic kidney disease (CKD) increase due to defective inactivation and excretion. Objectives: The aim of the study was to analyze associations between serum ADMA and NO levels and function in children with end stage renal disease (ESRD) on regular hemodialysis (HD). Subjects and methods: The study was included 30 children (17 males, and 13 females) with ESRD on regular hemodialysis aged 11.67±4.47 years, treated with HD for 4.77±2.61 years. Serum ADMA and NO levels and biochemical parameters were measured and echocardiography was performed. Serum ADMA and NO levels and biochemical parameters were also measured in the control group of 30 healthy individuals matched for age. Results: Pre-dialysis ADMA level in children with ESRD was 5.40 ± 0.59 mg/dL and was significantly extremely higher than in control group (1.01 ± 0.41 mg/dL; P <0.0001). Moreover, there was extremely high significant decrease in post-dialysis ADMA level (4.89± 0.40 mg/dL) compared with pre-dialysis ADMA level (5.40 ± 0.59 mg/dL; P < 0.0001) in children with ESRD. On the other hand, mean pre-dialysis level of NO in children with ESRD was 21.00 ± 2.26 mg/dL with extremely high significant decreased compared with control group (39.17 ± 4.13 mg/dL; P < 0.0001). Moreover, the mean pre-dialysis level of NO was 21.00 ± 2.26 mg/dL lower than post-dialysis level of NO with a significant increase (22.04 ± 1.20 mg/dL; P < 0.05). Pre-dialysis ADMA level no correlated with pre-dialysis NO level (r = -0.203; p < 0.282). While, Serum ADMA negative correlated with NO in post-dialysis (r = -0.415; p < 0.022). There were significant positive correlations between Kt/V and ADMA decline (r = 0.344; P < 0.05) and NO increment (r = 0.450; P < 0.01). There was no significant difference (p> 0.05) between males and females in mean pre-dialysis or post-dialysis ADMA levels. Moreover, there was no significant difference (p> 0.05) between males and females in mean pre-dialysis and post-dialysis NO levels. Conclusion: Increased ADMA levels seem to be associated with ESRD on regular hemodialysis. The ADMA levels seem to play an important role in the regulation of the NO production during HD. There was no affect of gender on mean pre-dialysis and post-dialysis levels of ADMA or NO.