PS-BPC11-9: ADMA/SDMA RATIO AND ITS RELATIONS TO URIC ACID AND ALBUMIN IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS IN INDONESIA

Abstract

Background and Aims: Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA), rarely reported together, are markers of endothel dysfunction and kidney function. ADMA was inversely related to albumin, while SDMA was positively correlated to albumin. Meanwhile, uric acid was positively correlated to both SDMA and ADMA. By using ADMA and SDMA as ratio, we postulated that their ratio can more precisely predict activity dimethylarginine dimethylaminohydrolase (DDAH), a key enzyme that metabolized ADMA, and not SDMA, and can be used as marker of NO activity. Low NO activity is related to high vascular tonus and peripheral resistance, hypertension and low Sodium excretion and cardiac output. Method: This was a cross-sectional study conducted in adults underwent chronic Continuous Ambulatory Peritoneal Dialysis (CAPD) in tertiary hospital in Jakarta, Indonesia. Uric acid, albumin, ADMA and SDMA levels were measured at the same time patients controlled to outpatient clinic after washout from hyperuricemia drug for 2 to 4 weeks. Analysis performed using Pearson for normal distribution data, Spearman for nonparametric analysis and linier regression test and ROC curve with SPSS v20. Results and Discussion: Total of 55 subjects (83%) were included, male 63.6%, mean age of 40.71 ± 14,4 year old. Median of CAPD use was 27 months. Causes of CKD were glomerulonephritis (47.3%), diabetes mellitus (25.5%), hypertension (25.5%) and polycystic kidney disease (1.8%). At the time of research, 90.9%, were uncontrolled hypertension patients. Median level of UA was 7.30 ± 1.59 mg/dl and 60% had UA levels of 7 mg/dl or higher. Albumin level lower than 3.5 g/dl (mean 3.55 ± 0.49 g/dl) were 24 patients (43.6%). Median ADMA level was 87.5 ± 16.64 ng/ml and SDMA level was 633.73 ± 231.54 ng/mL. Median ADMA/SDMA ratio was 0.13 + 0,08 ng/ml. ADMA, SDMA, ADMA/SDMA ratio were correlated with uric acid with p = 0.027 (95%CI 0.175–0.471), p < 0.001 (95%CI 0.688–0.928) and p < 0.001 (95%CI -14,96 to -5,03) with sensitivity and specificity 91% and 95%, 97% and 68% and 79% and 96%, respectively. ADMA, SDMA, ADMA/SDMA ratio were not statistically significantly correlated with albumin with p = 0.26, p = 0.14 and p = 0.23, respectively. Albumin level was caused by many factors that are not in the scope of this research, this might explain this result. Conclusion: ADMA/SDMA ratio had comparable sensitivity and specificity to ADMA or SDMA alone when correlated with uric acid in CAPD patients. Albumin might not correlated with ADMA, SDMA, or ADMA/SDMA ratio in CAPD patients.