Renal failureSep 28, 2020

Link between trimethylamine N-oxide levels and heart-related and overall death risk in dialysis patients

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 5, 2026

Abstract

In a study of 252 hemodialysis patients, high plasma levels (>4.73 μg/mL) were linked to a higher risk of mortality.

High TMAO levels were associated with increased rates of cardiovascular death.
A total of 123 patients died during the follow-up period, with significant mortality rates attributed to cardiovascular and cerebrovascular causes.
Kaplan-Meier analysis indicated a greater incidence of all-cause mortality in patients with high TMAO levels.
Cox regression analysis showed that high TMAO levels significantly predicted cardiovascular and all-cause mortality, even after adjusting for confounders.

Simplified

BACKGROUND: Trimethylamine--Oxide () is a proatherogenic and prothrombotic metabolite. Our study examined the association of plasma TMAO level with cardiovascular and all-cause mortality in hemodialysis (HD) patients. N

METHODS: Patients who were at least 18 years-old and received HD for at least 6 months were enrolled within 6 months. Patients with coronary heart disease, congestive heart failure, arrhythmia, or stroke within 3 months before study onset were excluded. The primary endpoints were cardiovascular and all-cause death, and the secondary endpoint was cerebrovascular death.

RESULTS: We recruited 252 patients and divided them into a high-TMAO group (>4.73 μg/mL) and a low-TMAO group (≤4.73 μg/mL). The median follow-up time was 73.4 months (interquartile range: 42.9, 108). A total of 123 patients died, 39 from cardiovascular disease, 19 from cerebrovascular disease, and 65 from other causes. Kaplan-Meier analysis indicated that the high-TMAO group had a greater incidence of cardiovascular death (Log-Rank: = 0.006) and all-cause death (Log-Rank: < 0.001). Cox regression analysis showed that high TMAO level was significantly associated with cardiovascular and all-cause mortality. After adjustment for confounding, this association remained significant for cardiovascular mortality (TMAO as a continuous variable: HR: 1.18, 95%CI: 1.07, 1.294, < 0.001; TMAO as a dichotomous variable: HR: 3.44, 95%CI: 1.68, 7.08, < 0.001) and all-cause mortality (TMAO as a continuous variable: HR: 1.14, 95%CI: 1.08, 1.21, < 0.001; TMAO as a dichotomous variable: HR: 2.54, 95%CI: 1.71, 3.76, < 0.001). p p p p p p

CONCLUSIONS: High plasma TMAO level is significantly and independently associated with cardiovascular and all-cause mortality in HD patients.

Key numbers

1.18

Increase in Cardiovascular Mortality Risk

Hazard ratio for as a continuous variable.

1.14

Increase in All-Cause Mortality Risk

Hazard ratio for as a continuous variable.

3.44

Higher Risk of Cardiovascular Death

Hazard ratio for as a dichotomous variable.

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Link between trimethylamine N-oxide levels and heart-related and overall death risk in dialysis patients

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