Asymmetric dimethylarginine and angiopoietin-like protein-2 are independent predictors of cardiovascular risk in pre-dia
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NEPHROLOGY - ORIGINAL PAPER
Asymmetric dimethylarginine and angiopoietin‑like protein‑2 are independent predictors of cardiovascular risk in pre‑dialysis non‑diabetic chronic kidney disease patients K. Ashokachakkaravarthy1 · Medha Rajappa1 · Sreejith Parameswaran2 · Santhosh Satheesh3 · G. Priyadarshini1 · P. S. Mohan Raj1 · G. Revathy1 · M. Priyadarssini1 Received: 23 January 2020 / Accepted: 24 April 2020 © Springer Nature B.V. 2020
Abstract Background Chronic kidney disease (CKD) is associated with increased cardiovascular (CVD) morbidity and mortality. Hence, this study was carried out to assess the biomarkers of endothelial dysfunction and inflammation as predictors of CVD risk in Indian patients with CKD. Methods In this case control study, we recruited 43 patients with CKD and 43 healthy control volunteers. Circulating levels of endothelial dysfunction markers [asymmetric dimethylarginine (ADMA), angiopoietin-like protein-2 (ANGPTL2), matrix metallopeptidase 9 (MMP-9)] and systemic inflammation [high-sensitivity C-reactive protein (hs-CRP)] were assessed in the study population. All study participants underwent brachial artery flow mediated dilation (FMD) to estimate endothelial dysfunction. Disease severity (e-GFR) was assessed by a nephrologist. Results CKD patients showed markedly elevated levels of ADMA, ANGPTL2, MMP-9, and hs-CRP. FMD and eGFR were significantly decreased in cases, as compared to the controls. ADMA, ANGPTL2, MMP-9 and hs-CRP showed significant positive correlation with one another and significant negative correlation with FMD and disease severity. We also observed a significant negative correlation of FMD with disease severity and duration of CKD. In the multiple linear regression model, ADMA and ANGPTL2 were found to be independent predictors of FMD. Conclusion In CKD patients, there is significantly increased endothelial dysfunction and systemic inflammation, which showed a positive correlation with disease severity. Thus, the markers of endothelial dysfunction such as ADMA and ANGPTL2 can be used as predictors of CVD risk in CKD. Keywords Chronic kidney disease · Endothelial dysfunction · Inflammation · High sensitivity C-reactive protein · Flowmediated dilation · Cardiovascular disease risk
Introduction This research work was presented as a poster during the 15th Asia–Pacific Congress of Clinical Biochemistry (APFCB), at Jaipur, India from 17–20 November 2019. * Medha Rajappa [email protected] 1
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Puducherry 605006, India
2
Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Chronic kidney disease (CKD) is a global health burden acquiring prodigious attention in recent times because of its high incidence and prevalence worldwide [1]. Cardiovascular disease (CVD) accounts f
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