Improving Proteinuria, Endothelial Functions and Asymmetric Dimethylarginine Levels in Chronic Kidney Disease: Ramipril versus ValsartanYilmaz M.I.a, f · Saglam M.b · Sonmez A.c · Caglar K.a · Cakir E.d · Kurt Y.d · Eyileten T.a · Tasar M.b · Acikel C.e · Oguz Y.a · Vural A.a · Yenicesu M.a
Departments of aNephrology, bRadiology, cInternal Medicine, dBiochemistry, and eEpidemiology, Gülhane School of Medicine, Etlik-Ankara, Turkey; fDivisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Background: The aim of this study was to find out whether the beneficial effects of the renin-angiotensin-aldosterone system (RAS) blockage in chronic kidney disease (CKD) has any relation with the alteration of asymmetric dimethylarginine (ADMA) levels. Methods: Sixty-six nondiabetic patients with CKD and proteinuria and 36 healthy subjects were enrolled. Patients were treated with either ramipril 5 mg daily or valsartan 160 mg daily for 3 months. Proteinuria, ADMA, symmetric dimethyl arginine (SDMA), flow-mediated dilatation (FMD) and HOMA index measurements were performed both before and after the treatment. Results: ADMA, SDMA, hsCRP levels, HOMA index and proteinuria of patients were significantly higher (p < 0.001 for all) and FMD, L-arginine and L-arginine/ADMA ratio in CKD were significantly lower than controls. According to the multiple regression analysis, proteinuria levels were independently related to ADMA and SDMA levels. Conclusion: Both drugs were equally effective in reducing elevated ADMA levels and improving endothelial dysfunction in CKD patients.
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