The Relationship Between Plasma ADMA And Vascular Endothelium Injury Of ESRD Patients In CAPD State

Objective:According to statistics,the incidence of chronic kidney disease is approximate to 10 percent,and chronic renal failure is the common result of the chronic kidney disease.There is no other effective treatment but replacement therapy and kidney transplant when they enter the end-stage renal disease.The patients of ESRD have high mortality whether received dialysis treatment or not.Especially the mortality of cardiovascular events is the most prominent.Cardiovascular disease is the primary cause of the death of the patients with ESRD.Therefore the risk factors for cardiovascular event of chronic kidney disease is carryed out extensively.ADMA is gradually recognized as the single risk factor of cardiovascular disease in recent years.ADMA is the inhibitor of endothelial nitric oxide synthase(eNOS),and makes the production of NO reduced.Therefore it has damaged the vascular endothelial function and the enhanced incidence of cardiovascular diseases.This study is to investigate the correlation of the plasma ADMA levels and endothelial function injury in patients with ESRD which led to high incidence of cardiovascular disease by being detected plasma ADMA and serum eNOS levels in patients with ESRD (including peritoneal dialysis patients).Meanwhile to evaluate the value of ADMA removd by peritoneal dialysis treatment.Methods:The 63 patients of end-stage renal disease were selected.The peritoneal dialysis treatment group was 30 cases.The uremia conservative treatment group was 33 cases and the healthy adult group was 32 cases.The age and gender among the three groups were matched.The plasma ADMA and serum levelof eNOS of the patients were measured and the ADMA level of peritoneal dialysis fluid in the early morning was measured.ADMA was measured by high performance liquid chromatography analysis and serum eNOS was measured by ELISA.The results were analysised by SPSS11.5 statistical software.Results:The plasma ADMA of the control group was 0.159±0.033μmol/l.The plasma ADMA of the conservative treatment group of uremic was 1.143±0.220μmol/l and the plasma ADMA of the peritoneal dialysis group was 0.541±0.102μmol/l.The three groups had statistically significant difference.The ADMA of the patients with normal blood pressure of peritoneal dialysis treatment was 0.284±0.219μmol/l,and the ADMA of the patients with hypertension of peritoneal dialysis treatment was 0.556±0.450μmol/l.The difference between the two groups was significant.The ADMA of the patients of uremia Conservative treatment with normal blood pressure was 0.457±0.447μmol/l,but the ADMA of hypertension patients was 1.240±1.330μmol/l.The differences between the two groups was significant.The eNOS of the uremia patients with the conservative treatment group was 5891.37±2408.82 pg/ml.The eNOS of peritoneal dialysis treatment was 6277.70±22469.30 pg/ml,and the eNOS of the control group was 6654.74± 2455.01 pg/ml.The peritoneal dialysis treatment group was lower than the control group,and the uremia conservative treatment group was the minimum,but there was no significant difference.Conclusion:The plasma ADMA level of the ESRD patients(including the conservative treatment group and peritoneal dialysis group)is significantly higher than the control group,and the serum eNOS is lower than the control group.It is suggested that the endothelial function disturbance in the patients of ESRD is related to the accumulation of the plasma ADMA.The plasma ADMA level of ESRD with hypertension is significantly higher than the normal blood pressure.It is suggested that the plasma ADMA is the risk factors of cardiovascular disease in ESRD patients.It can be used as a predictor of cardiovascular disease,and is a new uremic toxins.But the specific mechanism of ADMA will be studied further.The ADMA level of peritoneal dialysis treatment is significantly lower than the conservative treatment group.The ADMA of the peritoneal dialysis fluid is measured at the same time,and the serum eNOS is significantly higher.It is suggested that the peritoneal dialysis treatment can remove plasma ADMA partly.It is a protective measure for the incidence of cardiovascular Complications.Study the interference with the formation and metabolism of ADMA by drugs is worth to exploration in the future.