Role of Asymmetric Dimethylarginine (ADMA) in Chronic Kidney Disease

Endothelial dysfunction due to reduced bioavailability of nitric oxide (NO) is an early step in the course of atherosclerotic cardiovascular disease. NO is synthesized from L-arginine via the action of NO synthase, which is known to be blocked by endogenous L-arginine analogues such as asymmetric dimethylarginine (ADMA). ADMA is a naturally occurring amino acid found in plasma and various types of tissues. Plasma level of ADMA is reported to be associated with cardiovascular risk factors such as chronic kidney disease (CKD), being a strong predictor for cardiovascular disease and the progression of renal dysfunction in these patients. In this review, we discuss the molecular mechanisms for the elevation of ADMA levels in CKD. We also review here the pathological role for ADMA in cardiovascular complications in patients with CKD.