What is ADMA?

Asymmetric dimethylargenine (ADMA) is a naturally occurring amino acid, that had been known to biochemists for decades. However, the medical community started to gain interest in this substance as late as 1992 when Vallance and coworkers published their landmark paper on the elevation of dimethylarginines in patients with end stage renal disease. They speculated that the accumulation of ADMA, leading to an impaired NO synthesis, might contribute to the hypertension and immune dysfunction associated with chronic renal failure. As envisioned by Vallance et al., chronic kidney disease (CKD) has now emerged as the clinical situation that best epitomizes the potential importance of this substance in human diseases. The wide range of actions of this compound unravelled by studies performed over the last 10 years suggests that it may be involved in several alterations of the uremic state. It therefore is now formally listed as one of the “uremic toxins”. Thus far almost 400 publications on ADMA have been published. These studies now form a fairly coherent framework indicating that ADMA is not only an uremic toxin but also a strong marker of endothelial dysfunction and atherosclerosis and a solid predictor of mortality in selected patient populations. Notably, this substance is considered a common pathway mediating the adverse vascular effects of traditional and non-traditional risk factors.