Symmetric dimethylarginine is an independent predictor of intradialytic hypotension

Arduino Aleksander Mangoni, Christopher L Hewitson, Richard J Woodman, Malcolm J Whiting, Bridgit McAteer-Carr, Jeffrey A Barbara

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Hemodialysis (HD) is associated with significant reductions in the plasma concentrations of the nitric oxide (NO) inhibitors N(G)-monomethyl L-arginine (L-NMMA), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). We sought to determine whether elevated concentrations of these NO inhibitors pre-HD and/or their acute decrease during HD might mediate intradialytic hypotension (IDH). METHODS: Systolic blood pressure (SBP), L-arginine, L-NMMA, ADMA, and SDMA were measured at the beginning (pre-HD) and at the end (end-HD) in 52 consecutive HD patients (age 64.4 +/- 13.4 years). IDH was defined as a SBP reduction of >20 mm Hg end-HD vs. pre-HD. RESULTS: Fourteen patients demonstrated IDH. The mean SBP reduction during HD in this group was -35 +/- 13 mm Hg compared to an increase of +2 +/- 12 mm Hg among the 38 patients without IDH (no-IDH). Baseline demographic, clinical, and biochemical parameters did not differ between the IDH and no-IDH groups. However, the IDH group had higher pre-HD SBP (155 +/- 17 vs. 132 +/- 14 mm Hg, P <0.001), pre-HD plasma SDMA concentrations (1.98 +/- 0.61 vs. 1.64 +/- 0.46 micromol/l, P = 0.04), and greater SDMA reductions during HD (-0.78 +/- 0.43 vs. -0.56 +/- 0.32 micromol/l, P = 0.06) than the no-IHD group. After adjusting for pre-HD SBP, the odds of IDH occurring were higher with increased pre-HD SDMA plasma concentrations (OR = 1.31 per 0.1 micromol/l SDMA increase; 95% CI = 1.04-1.65, P = 0.02) and with decreases in SDMA during HD (OR = 1.39 per 0.1 micromol/l SDMA decrease; 95% CI = 1.02-1.91, P = 0.04). CONCLUSION: Increased pre-HD SDMA plasma concentrations and greater SDMA reductions during HD independently predict IDH after adjusting for demographic and clinical variables, pre-HD SBP, and other methylated forms of L-arginine.
Original languageEnglish
Pages (from-to)955-959
Number of pages5
JournalAmerican Journal of Hypertension
Volume21
Issue number8
DOIs
Publication statusPublished - Aug 2008

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Hypotension
Renal Dialysis
Blood Pressure
Arginine
N,N'-dimethylarginine
omega-N-Methylarginine
Nitric Oxide
Demography

Keywords

  • Aged
  • Arginine
  • Biological Markers
  • Blood Pressure
  • Female
  • Humans
  • Hypotension
  • Kidney Failure, Chronic
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Renal Dialysis
  • omega-N-Methylarginine

Cite this

Mangoni, A. A., Hewitson, C. L., Woodman, R. J., Whiting, M. J., McAteer-Carr, B., & Barbara, J. A. (2008). Symmetric dimethylarginine is an independent predictor of intradialytic hypotension. American Journal of Hypertension, 21(8), 955-959. https://doi.org/10.1038/ajh.2008.214

Symmetric dimethylarginine is an independent predictor of intradialytic hypotension. / Mangoni, Arduino Aleksander; Hewitson, Christopher L; Woodman, Richard J; Whiting, Malcolm J; McAteer-Carr, Bridgit; Barbara, Jeffrey A.

In: American Journal of Hypertension, Vol. 21, No. 8, 08.2008, p. 955-959.

Research output: Contribution to journalArticle

Mangoni, AA, Hewitson, CL, Woodman, RJ, Whiting, MJ, McAteer-Carr, B & Barbara, JA 2008, 'Symmetric dimethylarginine is an independent predictor of intradialytic hypotension', American Journal of Hypertension, vol. 21, no. 8, pp. 955-959. https://doi.org/10.1038/ajh.2008.214
Mangoni AA, Hewitson CL, Woodman RJ, Whiting MJ, McAteer-Carr B, Barbara JA. Symmetric dimethylarginine is an independent predictor of intradialytic hypotension. American Journal of Hypertension. 2008 Aug;21(8):955-959. https://doi.org/10.1038/ajh.2008.214
Mangoni, Arduino Aleksander ; Hewitson, Christopher L ; Woodman, Richard J ; Whiting, Malcolm J ; McAteer-Carr, Bridgit ; Barbara, Jeffrey A. / Symmetric dimethylarginine is an independent predictor of intradialytic hypotension. In: American Journal of Hypertension. 2008 ; Vol. 21, No. 8. pp. 955-959.
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abstract = "BACKGROUND: Hemodialysis (HD) is associated with significant reductions in the plasma concentrations of the nitric oxide (NO) inhibitors N(G)-monomethyl L-arginine (L-NMMA), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). We sought to determine whether elevated concentrations of these NO inhibitors pre-HD and/or their acute decrease during HD might mediate intradialytic hypotension (IDH). METHODS: Systolic blood pressure (SBP), L-arginine, L-NMMA, ADMA, and SDMA were measured at the beginning (pre-HD) and at the end (end-HD) in 52 consecutive HD patients (age 64.4 +/- 13.4 years). IDH was defined as a SBP reduction of >20 mm Hg end-HD vs. pre-HD. RESULTS: Fourteen patients demonstrated IDH. The mean SBP reduction during HD in this group was -35 +/- 13 mm Hg compared to an increase of +2 +/- 12 mm Hg among the 38 patients without IDH (no-IDH). Baseline demographic, clinical, and biochemical parameters did not differ between the IDH and no-IDH groups. However, the IDH group had higher pre-HD SBP (155 +/- 17 vs. 132 +/- 14 mm Hg, P <0.001), pre-HD plasma SDMA concentrations (1.98 +/- 0.61 vs. 1.64 +/- 0.46 micromol/l, P = 0.04), and greater SDMA reductions during HD (-0.78 +/- 0.43 vs. -0.56 +/- 0.32 micromol/l, P = 0.06) than the no-IHD group. After adjusting for pre-HD SBP, the odds of IDH occurring were higher with increased pre-HD SDMA plasma concentrations (OR = 1.31 per 0.1 micromol/l SDMA increase; 95{\%} CI = 1.04-1.65, P = 0.02) and with decreases in SDMA during HD (OR = 1.39 per 0.1 micromol/l SDMA decrease; 95{\%} CI = 1.02-1.91, P = 0.04). CONCLUSION: Increased pre-HD SDMA plasma concentrations and greater SDMA reductions during HD independently predict IDH after adjusting for demographic and clinical variables, pre-HD SBP, and other methylated forms of L-arginine.",
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T1 - Symmetric dimethylarginine is an independent predictor of intradialytic hypotension

AU - Mangoni, Arduino Aleksander

AU - Hewitson, Christopher L

AU - Woodman, Richard J

AU - Whiting, Malcolm J

AU - McAteer-Carr, Bridgit

AU - Barbara, Jeffrey A

PY - 2008/8

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N2 - BACKGROUND: Hemodialysis (HD) is associated with significant reductions in the plasma concentrations of the nitric oxide (NO) inhibitors N(G)-monomethyl L-arginine (L-NMMA), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). We sought to determine whether elevated concentrations of these NO inhibitors pre-HD and/or their acute decrease during HD might mediate intradialytic hypotension (IDH). METHODS: Systolic blood pressure (SBP), L-arginine, L-NMMA, ADMA, and SDMA were measured at the beginning (pre-HD) and at the end (end-HD) in 52 consecutive HD patients (age 64.4 +/- 13.4 years). IDH was defined as a SBP reduction of >20 mm Hg end-HD vs. pre-HD. RESULTS: Fourteen patients demonstrated IDH. The mean SBP reduction during HD in this group was -35 +/- 13 mm Hg compared to an increase of +2 +/- 12 mm Hg among the 38 patients without IDH (no-IDH). Baseline demographic, clinical, and biochemical parameters did not differ between the IDH and no-IDH groups. However, the IDH group had higher pre-HD SBP (155 +/- 17 vs. 132 +/- 14 mm Hg, P <0.001), pre-HD plasma SDMA concentrations (1.98 +/- 0.61 vs. 1.64 +/- 0.46 micromol/l, P = 0.04), and greater SDMA reductions during HD (-0.78 +/- 0.43 vs. -0.56 +/- 0.32 micromol/l, P = 0.06) than the no-IHD group. After adjusting for pre-HD SBP, the odds of IDH occurring were higher with increased pre-HD SDMA plasma concentrations (OR = 1.31 per 0.1 micromol/l SDMA increase; 95% CI = 1.04-1.65, P = 0.02) and with decreases in SDMA during HD (OR = 1.39 per 0.1 micromol/l SDMA decrease; 95% CI = 1.02-1.91, P = 0.04). CONCLUSION: Increased pre-HD SDMA plasma concentrations and greater SDMA reductions during HD independently predict IDH after adjusting for demographic and clinical variables, pre-HD SBP, and other methylated forms of L-arginine.

AB - BACKGROUND: Hemodialysis (HD) is associated with significant reductions in the plasma concentrations of the nitric oxide (NO) inhibitors N(G)-monomethyl L-arginine (L-NMMA), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). We sought to determine whether elevated concentrations of these NO inhibitors pre-HD and/or their acute decrease during HD might mediate intradialytic hypotension (IDH). METHODS: Systolic blood pressure (SBP), L-arginine, L-NMMA, ADMA, and SDMA were measured at the beginning (pre-HD) and at the end (end-HD) in 52 consecutive HD patients (age 64.4 +/- 13.4 years). IDH was defined as a SBP reduction of >20 mm Hg end-HD vs. pre-HD. RESULTS: Fourteen patients demonstrated IDH. The mean SBP reduction during HD in this group was -35 +/- 13 mm Hg compared to an increase of +2 +/- 12 mm Hg among the 38 patients without IDH (no-IDH). Baseline demographic, clinical, and biochemical parameters did not differ between the IDH and no-IDH groups. However, the IDH group had higher pre-HD SBP (155 +/- 17 vs. 132 +/- 14 mm Hg, P <0.001), pre-HD plasma SDMA concentrations (1.98 +/- 0.61 vs. 1.64 +/- 0.46 micromol/l, P = 0.04), and greater SDMA reductions during HD (-0.78 +/- 0.43 vs. -0.56 +/- 0.32 micromol/l, P = 0.06) than the no-IHD group. After adjusting for pre-HD SBP, the odds of IDH occurring were higher with increased pre-HD SDMA plasma concentrations (OR = 1.31 per 0.1 micromol/l SDMA increase; 95% CI = 1.04-1.65, P = 0.02) and with decreases in SDMA during HD (OR = 1.39 per 0.1 micromol/l SDMA decrease; 95% CI = 1.02-1.91, P = 0.04). CONCLUSION: Increased pre-HD SDMA plasma concentrations and greater SDMA reductions during HD independently predict IDH after adjusting for demographic and clinical variables, pre-HD SBP, and other methylated forms of L-arginine.

KW - Aged

KW - Arginine

KW - Biological Markers

KW - Blood Pressure

KW - Female

KW - Humans

KW - Hypotension

KW - Kidney Failure, Chronic

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Renal Dialysis

KW - omega-N-Methylarginine

U2 - 10.1038/ajh.2008.214

DO - 10.1038/ajh.2008.214

M3 - Article

VL - 21

SP - 955

EP - 959

JO - American Journal of Hypertension

JF - American Journal of Hypertension

SN - 0895-7061

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ER -