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Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients
AIMS: Sudden cardiac death (SCD) is a major contributor to the excess mortality of patients on maintenance dialysis. Homoarginine deficiency may lead to decreased nitric oxide availability and endothelial dysfunction. Based on this rationale we assessed whether homoarginine deficiency is a risk fact...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143829/ https://www.ncbi.nlm.nih.gov/pubmed/21791541 http://dx.doi.org/10.1093/eurjhf/hfr056 |
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author | Drechsler, Christiane Meinitzer, Andreas Pilz, Stefan Krane, Vera Tomaschitz, Andreas Ritz, Eberhard März, Winfried Wanner, Christoph |
author_facet | Drechsler, Christiane Meinitzer, Andreas Pilz, Stefan Krane, Vera Tomaschitz, Andreas Ritz, Eberhard März, Winfried Wanner, Christoph |
author_sort | Drechsler, Christiane |
collection | PubMed |
description | AIMS: Sudden cardiac death (SCD) is a major contributor to the excess mortality of patients on maintenance dialysis. Homoarginine deficiency may lead to decreased nitric oxide availability and endothelial dysfunction. Based on this rationale we assessed whether homoarginine deficiency is a risk factor for SCD in dialysis patients. METHODS AND RESULTS: This study examined the association of homoarginine with cardiovascular outcomes in 1255 diabetic haemodialysis patients from the German diabetes and dialysis study. During a median of 4 years of follow-up, hazard ratios (HR) (95% CI) for reaching the following pre-specified, adjudicated endpoints were determined: SCD, myocardial infarction, stroke, death due to heart failure, and combined cardiovascular events. There was a strong association of low homoarginine concentrations with the presence of congestive heart failure and left ventricular hypertrophy as well as increased levels of brain natriuretic peptide. Per unit decrease in homoarginine, the risk of SCD increased three-fold (HR 3.1, 95% CI 2.0–4.9), attenuating slightly in multivariate models (HR 2.4; 95% CI 1.5–3.9). Patients in the lowest homoarginine quintile experienced a more than two-fold increased risk of SCD, and more than three-fold increased risk of heart failure death than patients in the highest quintile, which accounted for the high incidence of combined cardiovascular events. Low homoarginine showed a trend towards increased risk of stroke, however, myocardial infarction was not meaningfully affected. CONCLUSION: Low homoarginine is a strong risk factor for SCD and death due to heart failure in haemodialysis patients. Further studies are needed to elucidate the underlying mechanisms, offering the potential to develop new interventional strategies. |
format | Online Article Text |
id | pubmed-3143829 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-31438292011-08-01 Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients Drechsler, Christiane Meinitzer, Andreas Pilz, Stefan Krane, Vera Tomaschitz, Andreas Ritz, Eberhard März, Winfried Wanner, Christoph Eur J Heart Fail Biomarkers AIMS: Sudden cardiac death (SCD) is a major contributor to the excess mortality of patients on maintenance dialysis. Homoarginine deficiency may lead to decreased nitric oxide availability and endothelial dysfunction. Based on this rationale we assessed whether homoarginine deficiency is a risk factor for SCD in dialysis patients. METHODS AND RESULTS: This study examined the association of homoarginine with cardiovascular outcomes in 1255 diabetic haemodialysis patients from the German diabetes and dialysis study. During a median of 4 years of follow-up, hazard ratios (HR) (95% CI) for reaching the following pre-specified, adjudicated endpoints were determined: SCD, myocardial infarction, stroke, death due to heart failure, and combined cardiovascular events. There was a strong association of low homoarginine concentrations with the presence of congestive heart failure and left ventricular hypertrophy as well as increased levels of brain natriuretic peptide. Per unit decrease in homoarginine, the risk of SCD increased three-fold (HR 3.1, 95% CI 2.0–4.9), attenuating slightly in multivariate models (HR 2.4; 95% CI 1.5–3.9). Patients in the lowest homoarginine quintile experienced a more than two-fold increased risk of SCD, and more than three-fold increased risk of heart failure death than patients in the highest quintile, which accounted for the high incidence of combined cardiovascular events. Low homoarginine showed a trend towards increased risk of stroke, however, myocardial infarction was not meaningfully affected. CONCLUSION: Low homoarginine is a strong risk factor for SCD and death due to heart failure in haemodialysis patients. Further studies are needed to elucidate the underlying mechanisms, offering the potential to develop new interventional strategies. Oxford University Press 2011-08 /pmc/articles/PMC3143829/ /pubmed/21791541 http://dx.doi.org/10.1093/eurjhf/hfr056 Text en Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissions@oup.com. http://creativecommons.org/licenses/by-nc/2.5/ The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Biomarkers Drechsler, Christiane Meinitzer, Andreas Pilz, Stefan Krane, Vera Tomaschitz, Andreas Ritz, Eberhard März, Winfried Wanner, Christoph Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title | Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title_full | Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title_fullStr | Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title_full_unstemmed | Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title_short | Homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
title_sort | homoarginine, heart failure, and sudden cardiac death in haemodialysis patients |
topic | Biomarkers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143829/ https://www.ncbi.nlm.nih.gov/pubmed/21791541 http://dx.doi.org/10.1093/eurjhf/hfr056 |
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