Trimethylamine N-Oxide and Cardiovascular Outcomes in Patients with ESKD Receiving Maintenance Hemodialysis

Jan 23, 2019Clinical journal of the American Society of Nephrology : CJASN

Trimethylamine N-Oxide and Heart Health in Patients with End-Stage Kidney Disease on Regular Dialysis

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Abstract

Approximately 80% of participants had serum TMAO concentrations ≥56M, with a maximum concentration of 1103.1M.

No association was found between serum TMAO levels and cardiovascular outcomes in patients with end-stage kidney disease.
The primary outcome, which included cardiovascular mortality and other serious cardiovascular events, showed no relation to TMAO concentrations.
Further analysis indicated no connection between TMAO and all-cause mortality or individual components of the composite outcome.
Higher TMAO concentrations were observed in white participants, but this did not confirm previous findings related to racial interactions.

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BACKGROUND AND OBJECTIVES: Trimethylamine-oxide (TMAO), a compound derived from byproducts 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. N

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured baseline serum TMAO concentrations in a subset of participants (=1243) from the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial and conductedanalyses evaluating the association between baseline serum TMAO and cardiovascular outcomes. n post hoc

RESULTS: We observed a wide distribution of serum TMAO in our cohort, with approximately 80% of participants exhibiting TMAO concentrations ≥56M and a maximum TMAO concentration of 1103.1M. We found no association between TMAO and 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 original EVOLVE primary outcome. Although we did observe higher TMAO concentrations in white participants, further subgroup analyses did not confirm the previously identified interaction between TMAO and race observed in a prior study in patients receiving dialysis. µ µ

CONCLUSIONS: We found no evidence linking TMAO to adverse clinical outcomes in patients receiving maintenance hemodialysis with moderate to severe secondary hyperparathyroidism.

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Trimethylamine N-Oxide and Cardiovascular Outcomes in Patients with ESKD Receiving Maintenance Hemodialysis

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