Asymmetric dimethylarginine level as biomarkers of cardiovascular or all-cause mortality in patients with chronic kidney disease: a meta-analysis

Abstract

Background

Studies have yielded conflicting findings on the association of asymmetric dimethylarginine (ADMA) level with cardiovascular or all-cause mortality in patients with chronic kidney disease (CKD). This meta-analysis sought to evaluate the association of blood ADMA level with cardiovascular or all-cause mortality in CKD patients.

Materials and methods

PubMed and Embase databases were comprehensively searched until September 9, 2020 for studies investigating the association of ADMA level with cardiovascular or all-cause mortality in CKD patients.

Results

Data were collected from nine prospective studies involving 6553 patients. The pooled adjusted risk ratio (RR) of all-cause mortality was 2.06 (95% confidence interval [CI] 1.43–2.96) for the highest versus the lowest ADMA level. Each 0.20 μmol/L ADMA increase was associated with 21% (95% CI 1.09–1.35) higher risk of all-cause mortality but not cardiovascular mortality (RR 1.07; 95% CI 0. 99–1.16). Subgroup analysis showed that each 0.20 μmol/L ADMA increase was significantly associated with all-cause mortality in end-stage renal disease (ESRD) patients (RR 1.22; 95% CI 1.05–1.41) but not in patients with stage 3 to 4 CKD (RR 1.16; 95% CI 0.86–1.56).

Conclusions

Elevated ADMA level is independently associated with higher risk of all-cause mortality in ESRD patients.

Keywords:

• Asymmetric dimethylarginine
• chronic kidney disease
• all-cause mortality
• cardiovascular mortality
• meta-analysis

Disclosure statement

The authors declare that they have no conflict of interest.

Author contributions

Y Fan contributed to study and guaranteed the integrity of study. H Zhang and SY Xiang searched the literature, extracted the data, assessed the study quality, and conducted the statistical analysis. H Zhang wrote the manuscript; Z Dai revised/edited the manuscript. All the authors read and approved the final version of manuscript.

Clinical significance

Circulating ADMA level is a powerful and independent predictor of all-cause mortality in CKD patients. CKD patients with the highest ADMA level had approximately 2.06-fold increased risk of all-cause mortality. Furthermore, each 0.20 μmol/L ADMA level increase was associated with 21% higher risk of all-cause mortality in CKD patients. The baseline ADMA level may improve risk classification of death in CKD patients.

Additional information

Funding

This work is supported by the Project Plan of Special Fund for Health Science and Technology Development in Nanjing [YKK19136].