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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Inflammation and asymmetric dimethylarginine for predicting death and cardiovascular events in ESRD patients
Clinical Journal of the American Society of Nephrology, Volume 6, No. 7, Year 2011
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Description
Background Endothelial dysfunction as assessed by asymmetric dimethylarginine (ADMA) and inflammation has been consistently linked to atherosclerosis, death, and cardiovascular (CV) events in ESRD patients. Inflammation amplifies the effect of ADMA on the severity of atherosclerosis in ESRD patients, but it is still unknown whether inflammation and ADMA interact in the high risk of death and CV events in this population. Design, setting, participants, & measurements In a cohort of 225 hemodialysis patients, we investigated the interaction between inflammatory biomarkers (C-reactive protein and IL-6) and ADMA as predictors of death and CV events over an extended follow-up (13 years). Results During follow-up, 160 patients died, and 123 had CV events. With crude and multiple Cox regression analyses, an interaction was found between inflammation biomarkers and ADMA for explaining death and CV events in ESRD patients. The adjusted hazard ratios (HRs) for death (HR, 2.18; 95% confidence interval [CI], 1.34 to 3.54) and CV outcomes (HR, 2.59; 95% CI, 1.47 to 4.55) of patients with C-reactive protein and ADMA above the median were higher than expected in the absence of interaction under the additive model (1.15 and 1.97, respectively) and significantly higher than in patients with only one biomarker above the median. Data analyses carried out by stratifying patients according to IL-6 provided similar results. Conclusions These data support the hypothesis that inflammation amplifies the risk of death and CV events associated with high ADMA levels in ESRD. These analyses further emphasize the need for intervention studies to attenuate inflammation and high ADMA levels in this population. © 2011 by the American Society of Nephrology.
Authors & Co-Authors
Tripepi, Giovanni Luigi
Italy, Palermo
Istituto Di Biomedicina ed Immunologia Molecolare Alberto Monroy
Sijbrands, Eric J.G.
Netherlands, Rotterdam
Erasmus Mc
Seck, Sidy Mohamed
Italy, Palermo
Istituto Di Biomedicina ed Immunologia Molecolare Alberto Monroy
Böger, Rainer H.
Germany, Hamburg
Universitätsklinikum Hamburg-eppendorf
Witteman, Jacqueline C.M.
Netherlands, Rotterdam
Erasmus Mc
Rapisarda, Francesco
Unknown Affiliation
Malatino, Lorenzo Salvatore
Italy, Catania
Azienda Ospedaliera Cannizzaro
Mallamaci, Francesca
Italy, Palermo
Istituto Di Biomedicina ed Immunologia Molecolare Alberto Monroy
Zoccali, Carmine
Italy, Palermo
Istituto Di Biomedicina ed Immunologia Molecolare Alberto Monroy
Statistics
Citations: 109
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.2215/CJN.11291210
ISSN:
1555905X
Research Areas
Environmental
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study