Improvement in central arterial pressure waveform during hemodialysis is related to a reduction in asymmetric dimethylarginine (ADMA) levels.

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Abstract

Cardiovascular mortality is high in hemodialysis (HD) patients. Early arterial pressure wave reflections, reflecting arterial stiffness and the endogenous nitric oxide synthesis inhibitor asymmetric dimethylarginine (ADMA) levels predict mortality in HD patients. Therefore, we aimed to study changes in ADMA levels and central arterial pressure waveform during HD.

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Most cited references 23

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Clinical applications of arterial stiffness; definitions and reference values.

Michael F O'Rourke, Jan Staessen, Charalambos Vlachopoulos … (2002)

Arterial stiffening is the most important cause of increasing systolic and pulse pressure, and for decreasing diastolic pressure beyond 40 years of age. Stiffening affects predominantly the aorta and proximal elastic arteries, and to a lesser degree the peripheral muscular arteries. While conceptually a Windkessel model is the simplest way to visualize the cushioning function of arteries, this is not useful clinically under changing conditions when effects of wave reflection become prominent. Many measures have been applied to quantify stiffness, but all are approximations only, on account of the nonhomogeneous structure of the arterial wall, its variability in different locations, at different levels of distending pressure, and with changes in smooth muscle tone. This article summarizes the methods and indices used to estimate arterial stiffness, and provides values from a survey of the literature, followed by recommendations of an international group of workers in the field who attended the First Consensus Conference on Arterial Stiffness, which was held in Paris during 2000, under the chairmanship of M.E. Safar and E.D. Frohlich.

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Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study

Ignazio Bellanuova, Alessandro Cataliotti, Lorenzo Salvatore Malatino … (2001)

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Effect of waiting time on renal transplant outcome.

S M Rudich, Lisa Hanson, Robert Port … (2000)

Numerous factors are known to impact on patient survival after renal transplantation. Recent studies have confirmed a survival advantage for renal transplant patients over those waiting on dialysis. We aimed to investigate the hypothesis that longer waiting times are more deleterious than shorter waiting times, that is, to detect a "dose effect" for waiting time. We analyzed 73,103 primary adult renal transplants registered at the United States Renal Data System Registry from 1988 to 1997 for the primary endpoints of death with functioning graft and death-censored graft failure by Cox proportional hazard models. All models were corrected for donor and recipient demographics and other factors known to affect outcome after kidney transplantation. A longer waiting time on dialysis is a significant risk factor for death-censored graft survival and patient death with functioning graft after renal transplantation (P < 0.001 each). Relative to preemptive transplants, waiting times of 6 to 12 months, 12 to 24 months, 24 to 36, 36 to 48, and over 48 months confer a 21, 28, 41, 53, and 72% increase in mortality risk after transplantation, respectively. Relative to preemptive transplants, waiting times of 0 to 6 months, 6 to 12 months, 12 to 24 months, and over 24 months confer a 17, 37, 55, and 68% increase in risk for death-censored graft loss after transplantation, respectively. Longer waiting times on dialysis negatively impact on post-transplant graft and patient survival. These data strongly support the hypothesis that patients who reach end-stage renal disease should receive a renal transplant as early as possible in order to enhance their chances of long-term survival.

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Author and article information

Journal

Journal ID (iso-abbrev): Nephron Clin Pract

Title: Nephron. Clinical practice

Publisher: S. Karger AG

ISSN (Electronic): 1660-2110

ISSN (Print): 1660-2110

Publication date (Electronic): 2007

Volume: 106

Issue: 4

Affiliations

[1 ] Department of Medical Sciences, Uppsala University, Uppsala, Sweden. inga.soveri@medsci.uu.se

Article

Publisher Item ID: 000104429

DOI: 10.1159/000104429

PubMed ID: 17596727

SO-VID: 31d67fb7-e47e-4fa3-9c18-9a3aa679f1d1

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Improvement in central arterial pressure waveform during hemodialysis is related to a reduction in asymmetric dimethylarginine (ADMA) levels.

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Abstract

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Karger: Nephrology

Most cited references 23

Clinical applications of arterial stiffness; definitions and reference values.

Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study

Effect of waiting time on renal transplant outcome.

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Cited by 7

Most referenced authors 372