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NDT Advance Access published online on September 3, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp439
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Synergistic effects of asymmetrical dimethyl-L-arginine accumulation and endothelial progenitor cell deficiency on renal function decline during a 2-year follow-up in stable angina

Andrzej Surdacki1, Ewa Marewicz2, Ewa Wieczorek-Surdacka3, Tomasz Rakowski1, Grzegorz Szastak1, Juliusz Pryjma2, Dariusz Dudek1 and Jacek S. Dubiel1

1 2nd Department of Cardiology 2 Department of Immunology 3 Department of Nephrology, Jagiellonian University, Cracow, Poland

Correspondence and offprint requests to: Andrzej Surdacki; E-mail: surdacki.andreas{at}gmx.net



  Abstract

Background. Renal insufficiency predisposes to coronary artery disease (CAD), but also CAD and traditional risk factors accelerate renal function loss. Endothelial progenitor cell (EPC) deficiency and elevated asymmetrical dimethyl-L-arginine (ADMA), an endogenous nitric oxide (NO) formation inhibitor, predict adverse CAD outcome. Our aim was to assess changes in estimated glomerular filtration rate over time ({Delta}eGFR) in relation to baseline EPC blood counts and ADMA levels in stable angina.

Methods. Eighty non-diabetic men with stable angina were followed up for 2 years after elective coronary angioplasty. Exclusion criteria included heart failure, left ventricular systolic dysfunction, eGFR <30 ml/min/1.73 m2 and coexistent diseases. Those with cardiovascular events or ejection fraction <55% during the follow-up were also excluded. A baseline blood count of CD34+/kinase-insert domain receptor (KDR)+ cells, a leukocyte subpopulation enriched for EPC, was quantified by flow cytometry (percentage of lymphocytes).

Results. A synergistic interaction (P = 0.015) between decreased CD34+/KDR+ cell counts and increased plasma ADMA, but not symmetrical dimethyl-L-arginine, was the sole significant multivariate {Delta}eGFR predictor irrespective of baseline eGFR. {Delta}eGFR was depressed in the simultaneous presence of high ADMA (>0.45 µmol/l, median) and low CD34+/KDR+ cell counts (<0.035%, median) compared to either of the other subgroups (P = 0.001–0.01). {Delta}eGFR did not correlate with traditional risk factors, angiographic CAD extent, levels of C-reactive protein and soluble vascular cell adhesion molecule-1.

Conclusions. Elevated ADMA and EPC deficiency may synergistically contribute to accelerated renal function decline in stable angina. This could result from the impairment of the EPC-dependent endothelial renewal in the kidney, an NO-dependent process.

Keywords: asymmetrical dimethyl-L-arginine; endothelial progenitor cells; renal function decline; stable angina

Received for publication: 2. 7.09
Accepted in revised form: 4. 8.09


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