Plasma asymmetric dimethylarginine and its association with cardiovascular risk factors in Vietnamese patients before and after kidney transplantation, 2018-2022.

Abstract

Background: Asymmetric dimethylarginine (ADMA) levels in patients with chronic kidney disease (CKD) are associated with cardiovascular events and mortality following kidney transplantation (KT). Therefore, ADMA may serve as a risk factor for cardiovascular complications in kidney transplant recipients. This study aimed to evaluate plasma ADMA concentrations and their association with cardiovascular risk factors in Vietnamese patients with end-stage renal disease (ESRD) before and after KT.

Methods: From January 2018 to December 2022, 75 patients with ESRD who underwent KT were clinically evaluated using Doppler ultrasound, laboratory tests, and ADMA quantification both before and 6 months after KT. Additionally, 80 healthy people were selected as a control group. ADMA levels before and after KT were statistically analyzed to identify associations with cardiovascular risk factors.

Results: The findings indicate that 100% of patients with ESRD before KT exhibited elevated levels of urea, creatinine, proteinuria, a long with a decreased glomerular filtration rate (GFR)< 60 ml/min. After KT, these abnormalities decreased to 17.3%, 41.3%, 5.3%, and 9.3%, respectively. Clinical indices such as hypertension, elevated CRP, anemia, left ventricular hypertrophy, and EF%< 50% were observed after KT at rates of 29.3%, 21.3%, 61.4%, and 34.7%, respectively. However, dyslipidemia and AIP > 0.11 increased by 2.6% and 10.7%, respectively, after KT compared to before. The average ADMA concentrations of patients before KT, after KT, and in healthy controls were 0.62 µmol/L, 0.57 µmol/L vs 0.17 µmol/L, respectively. Before KT, 93.3% of patients exhibited elevated ADMA levels, which decreased to 32.0% after KT. Males presented higher ADMA levels than females both before and after KT, as well as in healthy controls. ADMA levels showed minimal variation across different age groups. Before KT, dyslipidemia (cholesterol), AIP (> 0.11), and LA diameter were associated with increased ADMA levels. Lower hemoglobin and lower HDL-C levels at 6 months post-transplant were independently associated with an increased risk of ADMA elevation from pre-transplant to 6 months post-transplant.

Conclusion: ADMA levels in patients with end-stage renal disease were 3.65 times higher than those in healthy controls. Although ADMA levels decreased after KT, they remained elevated compared to healthy controls. Hemoglobin and LDL-C were independent factors associated with changes in ADMA concentration between the pre-transplant and six-month post-transplant periods.