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Asymmetric dimethylarginine level as biomarkers of cardiovascular or all-cause mortality in patients with chronic kidney disease: a meta-analysis

Abstract Background Studies have yielded conflicting findings on the association of asymmetric dimethylarginine (ADMA) level with cardiovascular or all-cause mortality in patients with chronic kidney disease (CKD). This meta-analysis sought to evaluate the association of blood ADMA level with cardiovascular or all-cause mortality in CKD patients. Materials and methods PubMed and Embase databases were comprehensively searched until September 9, 2020 for studies investigating the association of ADMA level with cardiovascular or all-cause mortality in CKD patients. Results Data were collected from nine prospective studies involving 6553 patients. The pooled adjusted risk ratio (RR) of all-cause mortality was 2.06 (95% confidence interval [CI] 1.43–2.96) for the highest versus the lowest ADMA level. Each 0.20 μmol/L ADMA increase was associated with 21% (95% CI 1.09–1.35) higher risk of all-cause mortality but not cardiovascular mortality (RR 1.07; 95% CI 0. 99–1.16). Subgroup analysis showed that each 0.20 μmol/L ADMA increase was significantly associated with all-cause mortality in end-stage renal disease (ESRD) patients (RR 1.22; 95% CI 1.05–1.41) but not in patients with stage 3 to 4 CKD (RR 1.16; 95% CI 0.86–1.56). Conclusions Elevated ADMA level is independently associated with higher risk of all-cause mortality in ESRD patients.