Research On The Influence Of Hemodialysision On The Level Of Uremic Serum Adma And Its Relationship With Cardiovascular Complications In ESRD Patients

Objective:ADMA as a marker of endothelial dysfunction and a ris k factor of cardiovascular diseases,has been gradually recognized and em phasized in recent years. Serum ADMA levels is associated with the mor bidity and mortality of end-stage renal disease (ESRD) patients with car diovascular disease (CVD).We determined the change of level of serum ADMA in end-stage renal disease (ESRD) patients who treated with div erse flux and different membrane dialyzers to evaluate the capability of hemodialysis on ADMA removal and explore the relationship between A DMA and CVD such as atherosclerosis and cardiac function in end-stag e renal disease (ESRD) patientsMethods:60ESRD patients who were treated in the blood purificati on center of the second hospital of Hebei medical university from Octo ber in2013to December in2013were selected,of whom31patients w ere male,the others were female.All selected patients who had been treat ed with Baxter CAHP-150/5M2734dialyzers which was named low-flux membrane cellulose diacetate (CD) dialyzers more than five months are in stable statusand,randomly and averagely divided into three groups.In first group the patients were treated with ployethersulfone (PES) high-fl ux membrane dialyzers and the second group used high-flux membrane cellulose triacetate (CTA) dialyzers while the patients in the third grou p continued to use low-flux membrane cellulose diacetate (CD) dialyzers. All dialyzers were reusable.The uremic dialysis patients were treated thr ee times every week and dialysis time was4hours every time.The valu e of Kt/V ranged from1.2to1.4.We selected20healthy volunteers a s control group.There were no statistical difference in sex and age in th e four groups.We recorded the serum levels of ADMA before and after hemodialysis every time and the levels after3months in uremic dialys is patients.Meanwhile,the morning elbow venous blood sample from20health control group were used to observe the same index.enzyme-linked immunosorbent assay (ELISA) was used to find the level of ADMA i n each group.We recorded the blood pressure every hour from beginnin g to ending theartment in uremic patients and calculated the mean arteri al blood pressure(MABP).Age,sex and other basic information of all part icipants were also recorded. Blood was drawed from every group in the morning with an empty belly to determinate albumin and other bioche mical criterion.Ultrasonic diagnostic equipment named Philips IE33was used to survey (LVD) left ventricular diameter,(LVPWT) left ventricular posterior wall thickness,(IVST) interventricu lar septal thickness and (L VEF)left ventricular ejection fraction.Ultrasonic diagnostic equipment na med Philips IU22was used to survey intima-media thickness(IMT) and atheromatous plaque.In every scanning we surveyed three times to count the average.All statistical data performed with SPSS16.0.P<0.05was co nsidered statistically significant.Results:1Compared with healthy controls,CD group,CTA group,and PES gr oup had higher serum ADMA (P<0.05).The serum ADMA content in co ntrol group was (0.34±0.14)μmol/L,while in CD group was the highest level with (1.23±0.15)umol/L and in PES group was the lowest level with (0.66±0.09)umol/L.Correlation Analysis between the serum ADMA content and conventional index showed ADMA levels was positively c orrelated with MABP(r=0.583,P<0.05) but negatively with Hb(r=-0.31,P<0.05).2Compared with the pre-hemodialysis level of ADMA in PES gro up,the post-hemodialysis were0.23±0.07umol/L and the differences were statistically significant.Meanwhile the post-hemodialysis levels of ADM A in CTA group and CD group were also lower than pre-hemodialysis. The differences were statistically significant in three groups.We found th ere was no difference between CTA and CD groups while the distingcti ons were obviously between PES group and other two groups.After thre e months,the level of ADMA was declined0.35±0.11umol/L in PES gro up,but the level in CTA group and CD group changed slightly.A statistic al difference was existing in three groups.We found there was no differ ence between CTA and CD groups while the distingctions were obviousl y between PES group and other two groups in the long run.3The CCA-IMT thickening ratio in ESRD patients(66.7%)was high er than healthy controls (15%).The distingction was statistically signific ant in two group.ESRD patients with carotid artery plaque had higher le vels of ADMA1.21±0.14umol/L) than those without plaques(0.77+0.15) umol/L(P<0.05). Statistical analysis showed positive correlation existed b etween serum ADMA level and CCA-IMT(R=0.997,P=0.000).Multiple ste pwise regression results showed that ADMA and MABP(r=0.587,P<0.05) were independently associated with IMT.The regression equation:Y=-0.38+1.631ADMA.4ESRD patients had higher LVMI(119.79±15.46g/m2) than health y controls(100.26±11.46g/m2) and of them patients with LVM(1.13±0.19umol/L) had higher ADMA level than patients without LVM(0.73±0.14umol/L)(P<0.05).Positive correlation existed between serum ADMA le vel and the LVMI(r=0.869,P<0.000).Multiple stepwise regression results showed that ADMA,dialysis age(3=-0.385,P<0.05) and MABP(r=0.592,P<0.05) were independently associated with LVM.The regression equation: Y=-0.38+1.631XADMA.Compared with normal controls(64.12±3.83)%,the LVEF was (61.51±6.50)%in ESRD patients.Negative correlation existed between serum ADMA level and the LVEF (r=-0.848,P<.000).Conclusions:1It is considered that serum ADMA content of ESRD patients is higher than control group.2It is supposed that PES is superior to CTA and CD in decreasin g ADMA content every time but it is not yet illustative that CTA is be tter than CD in removing ADMA.CTA and CD is inferior to PES in de creasing ADMA content in the long run3ESRD patients are liable to complicate with atherosclerosis comp ared with normal controls and serum ADMA level is crucial to the occ urrence and progress of atherosclerosis in ESRD patients.4LVH occurred frequently in ESRD patients compared with norma1controls and serum ADMA level plays an important role in the occurr ence and progress of LVH in ESRD patients...