Sequential change of ADMA levels after initiation of peritoneal dialysis in patients with ESRD (초)

Introduction: Cardiovascular risk is particularly high in patients with ESRD. ADMA has known as an independent predictor of CVD in ESRD patients. In order to observe the pattern of the change of ADMA levels and the correlation between these change and the clinical parameters, we measured the ADMA prospectively, baseline and every six months for one year after the initiation of PD. Subjects and Methods: Twenty-four patients who begun the standard CAPD were recruited in this study, and followed up for one year. Blood sample was collected at baseline and every six months for one year. Blood parameters included serum albumin, total cholesterol, glucose, urea nitrogen, creatinine. BMI, PET, weekly Kt/Vurea, nPCR, and creatinine clearance were also measured. Results: ADMA levels for one year were increased in ten patients(increase group), decreased in six(decrease group), and had no change in eight(no change group). The hemoglobin for initial six months in increase group increased as compared with decrease group(p=0.009). nPCR at 12 months was high in increase group(p=0.038). Hemoglobin levels had a positive correlation with ADMA levels at baseline(r=0.495, p=0.014). The change of ADMA levels for one year had positive correlation with the change of hemoglobin(r=0.592, p=0.002) and nPCR for same period(r=0.508, p=0.026). The correlation between the change of ADMA for one year and nPCR at 12 months was also observed(r=0.482, p=0.017). Conclusion: Our study suggests that the sequential change of ADMA level did not show the uniform pattern for one year after the initiation of PD, and it may influenced by individual difference than dialysis itself. The nutritional status of patients could influence on the change of ADMA. Therefore, in interpretation of ADMA level in ESRD patients on PD, it should be carefully considered difference of individual nutritional status.