Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 14, Issue 2, Pages 261-267Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.06190518
Keywords
cardiovascular disease; dialysis; end-stage renal disease; mortality; heart disease; renal dialysis; end-stage kidney disease; trimethylamine; trimethyloxamine; Rodentia; Kidney Failure, Chronic; Methylamines; Angina, Unstable; Hyperparathyroidism, Secondary; Myocardial Infarction; Stroke; Atherosclerosis; hospitalization; Bacteria; Oxides; Cohort Studies
Categories
Funding
- American Heart Association [15GRNT25700231]
- National Institutes of Health, National Institute of General Medical Sciences [R01-GM107122]
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Background and objectives TrimethylamineN-oxide (TMAO), a compound derived frombyproducts of intestinal bacteria, has been shown to accelerate atherosclerosis in rodents. To date, there are conflicting data regarding the association of serum TMAO with cardiovascular outcomes in patients with ESKD, a population exhibiting both high serum TMAO and excessive atherosclerosis. Design, setting, participants, & measurements We measured baseline serum TMAO concentrations in a subset of participants (n=1243) fromthe Evaluation of CinacalcetHydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial and conducted post hoc analyses evaluating the association between baseline serum TMAO and cardiovascular outcomes. Results We observed a wide distribution of serum TMAO in our cohort, with approximately 80% of participants exhibiting TMAO concentrations $ 56 mM and a maximum TMAO concentration of 1103.1 mM. Wefound no association between TMAOand our primary outcome, a composite of cardiovascular mortality, myocardial infarction, peripheral vascular event, stroke, and hospitalization for unstable angina. Moreover, in unadjusted and adjusted analyses, we observed no relation between TMAO and all-cause mortality, the independent components of our composite outcome, or the originalEVOLVEprimary outcome. Although we did observe higherTMAOconcentrations in whiteparticipants, further subgroup analysesdid not confirmthe previously identified interaction between TMAO and race observed in a prior study in patients receiving dialysis. ConclusionsWefound no evidence linking TMAOto adverse clinical outcomes in patients receiving maintenance hemodialysis with moderate to severe secondary hyperparathyroidism.
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