Chronic Kidney Disease (CKD) Patients With Serum Asymmetric Dimethylarginine Levels And Blood Pressure Variation Correlation Studies

Objective: To observe Chronic kidney disease （CKD） patients withoutdialysis serum asymmetric dimethyl arginine （ADMA） levels and bloodpressure circadian rhythm disappeared correlation and its effect ofcardiovascular and renal function, in order to reduce the spoon of visceradamage caused by blood pressure to provide clinical basis.Methods: Select the Second Hospital of Hebei Medical Nephrology,hospitalization and after discharge, patient review of primary glomerulardisease non-dialysis patients with120cases from March2012to September2012, and signed informed consent.Inclusion criteria:（1） comply with the K/DOQI chronic kidney disease diagnostic criteria;（2） All patients had completepatient consent. Exclusion criteria:（1） secondary kidney disease;（2）cardio-cerebral vascular accident, thyroid disease, liver disease, blooddisorders, cancer patients and snoring;（4） nearly a month of infection, obesity（BMI≥28kg/m²）;（5） prior to enrollment hormone or immunosuppressantmore than three months;（6） of cancer patients;（7） familial hyperlipidemia;（8）pregnancy. CKD-EPI equation to calculate glomerular filtration rate, dividedinto CKD_1-2 group CKD₃CKD_4-5 three groups,24-hour ambulatory bloodpressure monitoring and liquid chromatograph measured serum ADMAconcentration; collection renal indicators of blood lipids, blood sugar, urineprotein, and echocardiography. Results SPSS13.0statistical software forstatistical processing.Results：20cases CKD patients, male62cases, female58cases, aged23⁷1（43.4±13.2） years old, with a median duration of3.2years. Withhypertension,42cases,78cases of non-hypertensive. Serum ADMAconcentration CKD₃, CKD_4-5 three groups of patients①CKD_1-2 increased successively, were negatively correlated with renal function （p <0.05）.②CKD hypertension serum ADMA levels （3.528±1.704umol/l） wassignificantly higher than the non-hypertensive group （2.008±0.652umol/l, p<0.05）. Circadian blood pressure in the③CKD non-hypertensive patientsdisappeared group of50patients, the disappearance of a group of28patients,circadian rhythm circadian blood pressure disappears group ADMA level wassignificantly higher than the non-circadian rhythm disappeared group, astatistically significant difference.④serum ADMA level with Scr, UA, LVMI,urine protein, high-sensitivity C-reactive protein is associated with cardiacejection fraction was negatively correlated with lipids, blood glucose,hemoglobin no correlation. Multiple linear regression, the results showed thatthe eGFR, UA, LVMI, Hs-CRP, urinary protein ADMA elevatedindependently associated factors, the regression equation: Y=1.991-0.011X_eGFR±0.002X_UA±0.008X_LVMI±0.036X_hs-CRP-0.084X_{urine protein}.Conclusion：1Serum ADMA levels began to increase in the early CKD and elevatedserum ADMA level progressive with the progression of renal disease.2CKD hypertension group than in the non-hypertensive group ADMAlevels were significantly increased, and positively correlated with theincidence of hypertension, suggesting that ADMA involved in the occurrenceof renal hypertension.3CKD patients with ADMA levels and creatinine, uric acid, urine protein,hs-CRP, LVMI was positively correlated, negatively correlated with leftventricular ejection fraction, lipids, blood glucose is not found. PromptedADMA levels associated with micro-inflammatory state and oxidative stress,and speculated that the predictors of cardiovascular complications in patientswith CKD.4With the progression of renal disease, non-dipper-shaped bloodpressure ratio increases, and non-dipper-shaped blood pressure ADMAconcentrations were significantly higher than the blood pressure of the spoon-shaped, suggesting that ADMA involved in the formation ofnon-dipper-shaped blood pressure in patients with CKD, leading to thedisappearance of the circadian rhythm.