Dysregulated Arginine Metabolism and Left Ventricular Hypertrophy in Pediatric Chronic Kidney Disease and End Stage Renal Disease

Background: Cardiovascular disease (CVD) is the leading cause of death in patients with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). Left ventricular hypertrophy (LVH) is common in pediatric CKD patients and is an independent risk factor for cardiovascular (CV) morbidity/mortality. Nitric oxide (NO), an endothelium derived vasoactive substance critical for vascular homeostasis, is synthesized from arginine via NO synthase enzymes. Arginine is also a substrate for arginase enzymes therefore arginine bioavailability affects NO synthesis. The kidneys play a key role in de novo arginine synthesis as well as …