L-arginine to Reduce Sympathetic Nerve Activity in CKD Patients
Trial Parameters
Brief Summary
Chronic kidney disease (CKD) is associated with a higher risk of cardiovascular disease and death. An overactive sympathetic nervous system in CKD patients is one of the major mechanisms increasing the cardiovascular risks in this patient population. A potential signal driving sympathetic nerve activity (SNA) involves accumulation of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). ADMA is elevated in CKD and is a strong, independent predictor of future cardiovascular events in these patients. . The goal of this study is to determine whether overcoming the accumulation of endogenous ADMA with acute L-arginine infusion reduces SNA in CKD patients.
Eligibility Criteria
Inclusion Criteria: * CKD patients classified as Stage 3 and 4 of National Kidney Foundation Classification with estimated glomerular filtration rate (GFR) between 15 and 59 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease (MDRD) formula based on serum creatinine, age, gender, and race. * Men and women 35 to 75 years of age Exclusion Criteria: * myocardial infarction * heart failure * anemia (hemoglobin \<8 g/dl) * cancer with current treatment * previous organ transplantation * immunosuppressant therapy * human immunodeficiency virus infection * pregnancy and/or lactating * current tobacco use * taking menopausal drugs (estradiol) * treatment for diabetic neuropathy * resting heart rate ≥ 100 bpm and * systolic blood pressure ≤ 90 mmHg