New Findings Reframe SDMA’s Role in CKD-Related Cardiovascular Risk
When researchers at the University of Texas at Arlington set out to understand why people with chronic kidney disease (CKD) are at heightened risk for heart problems, they revisited a long-standing assumption. For years, ADMA—asymmetric dimethylarginine—has been considered a warning sign for vascular dysfunction. But a study published in the American Journal of Physiology-Renal Physiology reveals a surprising twist: SDMA, or symmetric dimethylarginine, which has often been regarded as relatively inactive, may actually offer a stronger signal about vascular health in CKD.
The traditional view: ADMA as the vascular red flag
Historically, clinicians and researchers watched ADMA levels as a proxy for endothelial function and cardiovascular risk. The idea was simple: higher ADMA would indicate poorer blood vessel health and greater risk of cardiovascular events. This framing guided many studies and influenced how physicians monitor patients with kidney disease. While ADMA remains a biomarker of interest, the UT Arlington team’s work suggests that a broader lens is needed when evaluating cardiovascular risk in CKD.
What the UT Arlington study found about SDMA and vascular health
Lead investigator Paul J. Fadel and colleagues focused on adults with CKD, selected particularly for moderate kidney disease (often stage 3). Their findings showed that SDMA levels were strongly related to kidney function—yet more importantly, higher SDMA correlated with weaker blood vessel function. In contrast, ADMA did not show the same robust association in this group. In plain terms, SDMA may serve as an early indicator of vascular problems in CKD patients, potentially flagging risk before dialysis becomes necessary.
As Fadel explained, “the background premise of the study is that people with chronic kidney disease do not die from their kidney problems. They die from cardiovascular disease.” The research sought to probe that link by examining blood vessel function directly, offering a lens into how the kidneys and vasculature influence each other. While the evidence suggests SDMA’s practical connection to vascular health, the researchers cautioned that the associations are modest and not sufficient to rely on SDMA alone as a standalone predictor.
Why this matters for patient monitoring and care
The study’s central takeaway is nuanced but clinically meaningful: SDMA measurement could complement existing monitoring strategies for CKD patients. By highlighting individuals with higher SDMA who also show signs of reduced vascular function, clinicians might identify at-risk patients earlier. Early identification could inform lifestyle interventions, medical management, and closer cardiovascular surveillance, potentially altering outcomes for those who might otherwise progress toward dialysis with unrecognized vascular risk.
Importantly, the researchers emphasize that SDMA is not a magic bullet. The strength of its association with vascular dysfunction was described as modest, underscoring the need for larger, longitudinal studies to confirm its predictive value and to explore how best to integrate SDMA testing into routine CKD care.
Next steps: expanding the evidence base
Fadel and his collaborators—the UT Arlington Human Neural Cardiovascular Control Lab team, postdoctoral researchers, doctoral students, and physician partner Ponnaiah Mohan—are calling for broader investigations. The goal is to determine whether SDMA can reliably forecast cardiovascular events over time, and whether interventions that modify SDMA-related pathways could mitigate risk for people with CKD. In the meantime, clinicians may consider SDMA as part of a more comprehensive assessment of vascular health in moderate CKD, alongside established markers and functional testing.
Conclusion: a shift in thinking about CKD and heart health
The UT Arlington study does not discard the relevance of ADMA, but it does shift attention toward SDMA as a potentially valuable biomarker for vascular function in CKD, especially in patients with stage 3 disease. By broadening the biomarker landscape, researchers hope to sharpen cardiovascular risk stratification and ultimately improve outcomes for people living with CKD.
Author notes
Lead author: Paul J. Fadel, University of Texas at Arlington, with a team of postdocs and doctoral students, plus collaborating clinicians.
