Differential Status of Serum Arginine, Arginase and Nitric Oxide in Patients of Chronic and Advanced Stage Kidney Disease Undergoing Hemodialysis

Abstract

Background: Chronic kidney disease (CKD) is characterized by deterioration of endothelial function which is associated with reduced availability of nitric oxide. The objective of the study was to assess the differential status of the serum levels of arginine, arginase, NO, urea and creatinine in CKD patients not on hemodialysis and in end stage renal disease (ESRD) patients receiving hemodialysis. Material and Methods: In this case control study, clinically diagnosed 30 CKD patients (group I), 30 ESRD patients before hemodialysis (Group II), 30 patients with ESRD after first hemodialysis (group III) and 30 patients with ESRD after second hemodialysis (Group IV) were included. 30 healthy volunteers were included for comparison. Serum arginine, arginase, nitric oxide, urea and creatinine were estimated by colorimetric and spectrophotometric methods. Results: Serum creatinine and urea levels were evaluated to determine the severity of renal dysfunction. A significantly decreased serum arginine and nitric oxide levels whereas significantly increased serum arginase levels were observed in ESRD patients when compared to levels in CKD patients. Serum creatinine levels were significantly decreased after second hemodialysis. But there was no significant change in the serum levels of arginine, arginase and nitric oxide in ESRD patients after first and second hemodialysis compared to pre-dialysis group. Conclusion: The findings of the study throw light upon the differential status of serum arginine, arginase and nitric oxide in CKD and in ESRD patients. The evaluation of decreased nitric oxide levels coupled with elevated arginase activity may help in assessing progression of CKD to ESRD along with traditional markers of kidney function. Additionally, evaluation of serum arginase activity may provide useful prognostic information, with large study group and further follow-up, in hemodialysis patients.