Clinical Impact of Serum Level of Adrenomedullin on Cardiac Functions and Volume Status in Haemodialysis Patients

Abstract

Cardiovascular disease (USRDS, 2009), excessive blood volume (Stegmayr, 2003), and systemic inflammation (DeFilippi, et al, 2003; Hocher, et al, 2003) are the major causes of mortality in hemodialysis patients. Early diagnosis and treatment of cardiovascular disease and excessive blood volume and systemic inflammation may lead to improved survival in hemodialysis patients (Yoshihara F, et al., 2005). For this purpose, a noninvasive biochemical testing method would be ideal to screen for, and monitor cardiac condition, blood volume, and inflammatory status. Adrenomedullin (AM), a 52-amino-acid peptide derived largely from vascular tissues, has numerous effects within the kidneys and on the cardiovascular and rennin-angiotensin systems (Hinson, J. P., Kapas, S., and Smith, D. M, 2000). These protean actions of adrenomedullin are generally seen as protective against injury due to hypertension, cardiovascular trophic and toxic factors, and infection (Hinson, J. P., Kapas, S., and Smith, D. M, 2000; Eto T, and Kitamura K, 2001). The hormone circulates in higher than normal concentrations in patients with renal impairment and is altered variably by haemodialysis (Yamasaki H, et al., 2001; Suda T, et al., 2002; McGregor DO, et al., 2003; Tokura T, et al., 2003). Numerous studies showed that plasma AM levels were increased in left ventricular (LV) failure (Øie E, et al., 2010), myocardial infarction (Khan SQ, et al., 2007), and peripheral arterial occlusive disease (Suzuki, et al, 2004), according to the disease severity.