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Background: Chronic kidney disease (CKD) is a pathophysiological process with various etiologies resulting in a progressive decline in kidney function and generally ends in kidney failure. During hemodialysis, inflammation and activation of TNF-α and other proinflammatory cytokines occur. This inflammatory condition causes a decrease in the effectiveness of HD in reducing the mortality of patients with CKD. Garlic has the potential as an anti-inflammatory agent due to its high antioxidant content in garlic. This study aimed to determine the effectiveness of garlic extract (Allium sativum) on decreasing serum levels of tumor necrosis factor-α (TNF-α) in chronic hemodialysis patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Methods: This study is an experimental study with a randomized, controlled, double-blind trial crossover design. A total of 40 research subjects participated in this study which was grouped into treatment (garlic extract) and placebo groups. TNF-α levels were measured using the ELISA method. Data analysis was carried out using SPSS univariate and bivariate. Results: The results of the study showed that the administration of garlic extract was able to reduce TNF-α levels by 12.5 pg/mL, p

Background: Rheumatoid arthritis (AR) is an autoimmune disease characterized by chronic and progressive systemic inflammation, in which the joints are the main target. AR has long been associated with increased cardiovascular risk. Vascular inflammation plays an important role in atherosclerosis. In AR, there is an increase in IL-17, which accelerate the formation of atherosclerosis. In Indonesia alone, there is no data that publishes the correlation between IL-17 levels with carotid IMT and the severity of AR. Methods: This type of research is a descriptive observational study with a correlation test approach. A total of 31 subjects participated in this study who were AR patients and calculated a DAS score of 28. Carotid IMT was measured by high-resolution carotid Doppler ultrasound B-mode ultrasound machine (PHILIPS, iE33) equipped with an 11 MHz linear array transducer. IL-17 was measured by the ELISA method. Data analysis was performed with a correlation test with SPSS software version 25. Results: There was a strong positive correlation between IL-17 and the degree of disease activity in AR (DAS28 score) with r = 0.657; p = 0.0001; n=31. There was no significant correlation between carotid IMT and IL-17 levels (r= 0,207; p=0,264; n=31). Conclusion: There is a strong positive correlation between IL-17 and the degree of AR disease activity. There was no significant correlation between carotid IMT and IL-17 levels.

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The clinical manifestation of COVID-19 is broad, ranging from an asymptomatic carrier state to severe disease leading to the death penalty. There is also emerging evidence that kidneys are affected early in COVID-19. Proteinuria and haematuria have been reported in 44% and 26.7% on admission, respectively. This literature review shows clinical manifestations of acute kidney injury (AKI) in a patient with COVID-19 infection. Literature reviews are carried out on various sources found on Google Scholar and Pubmed to search for articles, journal research, case reports, systematic reviews, meta-analyses, and textbooks. Various studies demonstrate the possibility of coronavirus infecting the kidney with several mechanisms such as cytokine storm syndrome (CSS), direct viral infection, and imbalance of renin-angiotensin-aldosterone (RAAS). Haematuria and proteinuria are associated with higher mortality and may signify aggressive disease early. Thus all patients should have a baseline urinalysis. There is a number of different causes of AKI in COVID-19, and some mechanisms by which COVID-19 affects kidneys remain unclear.

Coronary Slow Flow Phenomenon (CSFP) is characterized by the slow flow of contrast in one or more epicardial coronary vessels without evidence of coronary artery stenosis during coronary angiography procedures. CSFP is fairly common at the time of elective angiography with an incidence of around 7% and accounts for about 4% of hospitalized unstable angina cases. Coronary angiography is currently still the only effective way to detect CSFP, but this procedure is an invasive procedure with high costs, there is a risk of allergy to contrast. Electrocardiography (ECG), as a widely available, inexpensive, and simple modality is felt to be an attractive alternative in early detection of this abnormality. The ECG parameters on CSFP discussed in this study include; p-wave dispersion, QT interval dispersion, QRS intrinsic (Tpeak-Tenddeflection duration), and QRS fragmentation. Further studies are needed on the ECG image in CSFP so that in the future ECG can be a cheaper and non-invasive diagnostic modality for CSFP compared to coronary angiography.

Penelitian Chronic Renal Insufficiency Cohort (CRIC) menunjukkan 86% subjek PGK terbukti menderita inflamasi. Sejumlah studi longitudinal melaporkan peningkatan inflamasi dengan mengukur interleukin-6 (IL-6) pada pasien PD baik kadarnya di sistemik dan intraperitoneal. Bawang putih dan komponennya memiliki aktivitas antiinflamasi dan antioksidan. Efek antiinflamasi dari ekstrak bawang putih, dengan menghambat aktivasi jalur pro-inflamasi serta menghambat aktivasi makrofag dan efek antioksidan dan menghambat enzim pro-oxidant. Penelitian ini merupakan studi crossover randomized placebo controlled double blind trial. Subjek penelitian 20 orang pasien PGK stadium 5 yang menggunakan CAPD, dibagi secara acak menjadi 2 kelompok, yaitu kelompok yang mendapat ekstrak bawang putih 800 mg perhari (2x400 mg) selama 8 minggu dan kelompok yang mendapatkan placebo, kemudian dilakukan periode wash out selama 2 minggu dan setelah itu kedua kelompok diberikan perlakuan bergantian. Masing masing kelompok diukur kadar IL-6 serum, IL-6 dialisat dan net ultrafiltrasi sebelum dan sesudah perlakuan. Didapati kadar IL-6 serum sebelum dan sesudah pemberian ekstrak bawang putih 7,10 ±2,30 pg/ml dan 5,00±3,00 pg/ml dengan p= 0,005. Kadar IL-6 dialisat sebelum dan sesudah pemberian ekstrak bawang putih 39,20±2,10 pg/ml dan 33,20±7,80 pg/ml dengan p = 0,000. Disimpulkan penurunan kadar IL-6 serum dan dialisat sesudah ekstrak bawang putih pada penderita PGK stadium V yang menggunakan CAPD di RSMH Palembang.

Introduction. Human Immunodeficiency Virus (HIV) infection has been a concerning health problem worldwide. It causes reduction in body immune system and inflammation that can affect its clinical profile. Undergoing ARV therapy patients causes intestine microbiota dysbiosis and translocation that lead to imperfect absorbtion of fatty acid. One way to control microbiota dysbiosis is by controlling the nutritional factor, especially with omega-3. However, different regions upstands different custom in fish consumption especially those of which are rich in omega-3. The purpose of this research is to compare omega-3 serum level between HIV-AIDS patients and healthy population, as well as analyzing the correlation of omega-3 serum level with of HIV-AIDS patient clinical profile.Methods. The research will be applying observational analytic study using comparative study approach which will be performed in Tropical Infection Internal Medicine polyclinic and Medical Check-Up Polyclinic in RSMH Palembang starting from April 2020 until January 2021. Sample consisted of 32 HIV-AIDS patients from 20-58 years of age and 16 healthy population from 27-35 years of age on whom will be performed physical examination as well as clinical profile and omega-3 serum level examination. All data processing and analysis will be performed using SPSS v.25 for windows.Results. Out of 32 HIV-AIDS patients, we obtained low omega-3 serum level with median value at 3 (2-4) Umol/L, while in healthy population was 4 (3-6) Umol/L. Multivariate analysis inferred that the lower omega-3 serum level correlated with HIV-AIDS stage, duration of ARV therapy, blood pressure, and sex.Conclusion. Omega-3 serum levels in HIV-AIDS patients were lower than the healthy population. There was a correlation between omega-3 serum levels and their clinical profile of HIV-AIDS patients in Mohammad Hoesin General Hospital Palembang.

Background. Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, cost of care and non recovery of kidney function that leads to progression to chronic kidney disease. Cell cycle arrest is implicated in the pathogenesis and repair process following AKI. The urinary cell-cycle arrest markers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP-7) have been utilized to predict the risk of AKI in many studies from specific population with good performance. However, their use in predicting recovery is still lacking. The aim of this study was to determine the association between two novel AKI biomarkers, urinary TIMP2 and IGFBP7 and renal recovery after 7 days of treatment in AKI patients at Dr. Mohammad Hoesin Hospital Palembang. Method. This was a prospective cohort study conducted in dr. Mohammad Hoesin Hospital Palembang from January 2021 until March 2021. Subjects enrolled in this study were patients whom diagnosed AKI based on KDIGO 2012 criteria. Urine samples were collected upon patients’ enrollment within 24 hours of AKI diagnosis. We utilized Sandwich Enzyme Linked Immunosorbant Assay (ELISA) method to detect urinary TIMP-2 and IGFBP-7 levels. The primary outcome is recovery from AKI after 7 days of treatment. Chi square test is used to analyze the association between urinary TIMP-2 and IGFBP-7 levels and renal recovery. Results. There were 70 subjects, only 22 of them were recovered after 7 days (31%). Median of urinary TIMP-2 and IGFBP-7 was 0,0047(0,0001-0,1439) [(ng/ml)2/1000]. There was significant association between urinary TIMP2 and IGFBP7 and renal recovery (p=0,027; OR 3,19; 95% CI 1,116-9,128). Conclusion. There was significant association between urinary TIMP2 and IGFBP7 and renal recovery in AKI patients.

Background: Eclampsia and severe preeclampsia is of the most frequent cause of maternal death. We usually find the case like this in our daily practice. The case most likely could be prevented. Eclampsia defined as a generalized seizure following preeclampsia in pregnancy. Eclampsia/Preeclampsia (EPH-Gestosis) cause a multisystem dysfunction such as HELLP syndrome, microangiopathy hemolytic anemia, liver dysfunction, and thrombocytopenia. Eclampsia and HELLP syndrome lead to maternal mortality, which happened mostly during third trimester. Most of the patient came to the hospital in a bad condition where the multi organs failure were exist. EPH-Gestosis are due to maternal death in 43,75%. Even the case usually severe, it’s a preventable death. A proper strategy is needed to reduce or to avoid the maternal death.Objective: To analyse a maternal death with eclampsia and how to prevent this recurrent death.Case Report: A woman, 30 years old, G2P1A0 32 weeks pregnant not in labor with antepartum eclampsia was admitted to Mohammad Hoesin General Hospital (MHGH) Palembang, a referral case. Patient experienced generalized seizure six times before coming to MHGH which every seizure duration is less than five minutes and unconscious. On physical examination, patient was conscious, with blood pressure of 160/100 mmHg, pale, and cold extremities. By ultrasound examination, it showed 34 weeks pregnancy with single life fetus. Laboratory examination showed leukocytosis (25.000/mm3), thrombocytopenia (58.000/mm3), hyperbilirubinemia, elevated SGOT and SGPT (1691 and 861 U/L), elevated creatinine serum (2,46 mg/dl), and elevated LDH (3629 U/L). The patient was treated based on the protocol for stabilization with intramuscular injection of MgSO4 40%, nifedipin 10 mg per oral, intravenous injection of dexamethasone 12 mg, and plan to terminate the pregnancy by caesarean procedure. The male baby was born, 2000 g weight and APGAR score 4/6/8. After the cesarean the consciousness not so well. Collaborating therapy to handle the case, with the anesthesiologist, internist and neurologist. Maternal death occurred in 3 days hospitalized …caused by multi organ failure (MOF). Conclusion: The maternal death caused by antepartum eclampsia and the complication. The diagnosis of antepartum eclampsia and HELLP syndrome was decided based on history taking, physical examination, and supporting examination. Multiple organ failure exist in this case when the patient came to MHGH. Patient already treated and tried to overcome the complication but maternal death still occurred. This maternal death has a likely same story of previous death pattern. It is needed a strategy to prevent or to reduce the maternal death and how to make a good effort to cease the case become severe or worst.

Anemia contributes to increased morbidity and mortality in chronic kidney disease patients. The pathogenesis of anemia in these patients is multifactorial, but the contribution of erythropoietin deficiency becomes greater as glomerular filtration rate declines which related to decreased nephron mass. The current standard of care includes supplemental iron, erythropoiesis-stimulating agents (ESA), and red blood cell transfusions, although each has drawbacks. Lately, concern has arisen following randomized clinical trials showing that higher hemoglobin targets and/or high ESA doses may cause significant harm including increasing cardiovascular and thrombotic events, and even death. Recent experimental and clinical studies show the promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulates endogenous erythropoietin production and enhance iron availability.

A B S T R A C TAnemia contributes to increased morbidity and mortality in chronic kidney diseasepatients. The pathogenesis of anemia in these patients is multifactorial, but thecontribution of erythropoietin deficiency becomes greater as glomerular filtrationrate declines which related to decreased nephron mass. The current standard ofcare includes supplemental iron, erythropoiesis-stimulating agents (ESA), and redblood cell transfusions, although each has drawbacks. Lately, concern has arisenfollowing randomized clinical trials showing that higher hemoglobin targets and/orhigh ESA doses may cause significant harm including increasing cardiovascular andthrombotic events, and even death. Recent experimental and clinical studies showthe promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulatesendogenous erythropoietin production and enhance iron availability.

BACKGROUND: Diabetic nephropathy (DN) is a chronic kidney disease with microvascular complications which influence a patient’s quality of life and poses a potentially significant economic burden. The discovery of new biomarkers is needed to gain a better understanding and find additional treatment approaches beyond controlling plasma glucose and blood pressure. The engulfment and cell motility protein called engulfment and cell motility protein (ELMO)-1 is known to play a role in tissue remodeling and is associated with DN progression in animal models. Human studies correlating this protein with DN have been limited, although a genetic variation of ELMO-1 has been associated with DN. AIMS: This research aimed to investigate the association and correlation of circulating ELMO-1 with the level of kidney damage in DN. METHODS: The research design was cross-sectional. In this study, 60 patients with type 2 diabetes mellitus (T2DM) participated. Patients’ blood pressure, plasma glucose, and renal function parameters were measured to confirm the diagnosis. Albumin to creatinine ratio (ACR) was used to assess the level of kidney damage and determines DN group. RESULTS: Analyses shown the severity of albuminuria which is associated with plasma ELMO-1 when DN is evident. Furthermore, in all study participants, plasma ELMO-1 was correlated with increased proteinuria, ACR, and decline of glomerular filtration rate. CONCLUSIONS: Our research findings provide support for ELMO-1 as a promising marker of kidney damage level in patients with T2DM, especially when DN has occurred. Larger sample sizes and multicenter research in the Indonesian population are needed to confirm these results.

Chronic kidney disease (CKD) is associated with high mortality rates related to cardiovascular complications. Atherosclerosis, arteriosclerosis and vascular calcification conditions are often found in CKD patients. Carotid intima media thickness (cIMT) thickening is one of the parameters of vascular disorders. A cross sectional study was conducted on patients with chronic kidney disease in the hospital. Mohammad Hoesin Palembang. Patients' blood samples were examined in the hospital laboratory. CIMT thickening was examined using echocardiography. A total of 55 patients with stage 3-5 chronic kidney disease were examined. The median cIMT is 0.8 (0.6-1.45) mm. Spearman's correlation analysis showed a significant correlation between triglyceride levels and thickening of cIMT (r = 0.303, p = 0.025). A significant correlation was also shown between phosphate levels and cIMT thickening (r = 0.290, p = 0.032). There is a significant correlation of triglyceride levels and phosphate levels to cIMT thickening in patients with chronic kidney disease in Palembang

Background and aims. Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is the primary etiology of ESRD in Indonesia. It is estimated that there are 10 million patients with DM in Indonesia and about 25-40% of diabetics develop diabetic nephropathy (DN) within 25 years. Poor glycemic control is associated with increased mortality in a large observational study among diabetics on hemodialysis. Glycated hemoglobin, or known as HbA1c, was the currently recommended biomarker to monitor long-term glycemic control in diabetes mellitus guideline. However, it becomes underestimated in patients with DN on hemodialysis (DN-HD), because of 20- 50% reduction of erythrocyte lifespan, clinical use of iron therapy, and effects of recombinant human erythropoietin. Glycated albumin (GA), ketoamine formed via a non-enzymatic glycation reaction of serum albumin, is free from interference by erythrocyte lifespan or erythropoietin therapy and subsequently can be used as an alternative biomarker to monitor glycemic control in DN-HD. As albumin has a half-life of only 14-21 days* compared to Hb 60-100 days in well ESKD patients, thus GA may provide a better reflection of recent diabetic control than HbA1c. The aim of this study was to analyze the correlation between GA and HbA1c with glycemic control in DN-HD. Methods The study was an analytical observational study with a cross-sectional design. The subjects were consecutive patients with DN-HD who visited Hemodialysis Unit at Mohammad Hoesin General Hospital Palembang during August-November 2014. The glycemic control index was determined by the average value of 2 times a week pre-HD random blood glucose for 4 weeks (aRBG). Results. The subjects were 25 patients with an average age of 56.16±7.49 years old. The average value of GA was 26.94±7.74%. GA was strongly correlated with aRBG with r=0.776; p=0.000. After correcting for age, sex, and BMI, the correlations became significantly very strong (r=0.809, p

BACKGROUND: The coronary slow flow phenomenon (CSFP) is believed to be affected by endothelial dysfunction ruled by renin, angiotensin, aldosterone, and the angiotensin-converting enzyme (ACE). The gene of ACE has been characterized in humans by a major insertion (I)/deletion (D) polymorphism. Serum ACE levels were associated with I/D polymorphism in the ACE-encoding gene. AIM: This study explored and analyzed the role of ACE gene polymorphism risk factors with the incidence of CSFP in the population of South Sumatra, Indonesia. METHODS: This study was a cross-sectional analytic observational study. A total of 112 CSFP and non- CSFP patients participated in this study. Blood was obtained from the study subjects then processed. Angiotensin I and aldosterone levels were examined using the enzyme-linked immunosorbent assay. The Judkins method was used in the assessment of coronary angiography, which was carried out through the femoral artery. For the examination of ACE I/D polymorphisms, genome deoxyribonucleic acid was extracted from blood cells (leukocytes), using the Wizard’s purification system and examined using the polymerase chain reaction method. All data were evaluated through the Chi-square test, two samples t-test, and Mann–Whitney U-test. All tests used two-sided significance and p < 0.05 was considered statistically significant. RESULTS: ACE I/D gene polymorphism possessed a significant effect in increasing the risk of CSFP. Genotype II polymorphism increased the risk of CSFP as much as 6.9 times compared to individuals with ID/DD genotype. The existence of allele I increased the risk of CSFP 5.7 times compared to allele D. Levels of angiotensin I and aldosterone were increased significantly in patients with CSFP. CONCLUSION: ACE I/D gene polymorphism possessed a significant effect in increasing the risk of CSFP. Genotype of II was the risk factor for the development of CSFP in population of South Sumatra, Indonesia.

Introduction. Chronic kidney disease (CKD) is associated with high mortality rates, mainly as a result of cardiovascular complications. Meanwhile, recent studies have suggested a role of a homodimer protein called activin A in chronic kidney disease-mineral and bone disorder (CKD-MBD) conditions that may exist in the vascular calcification and osteolytic process. Ultrasound examination of the carotid intima-media thickness (cIMT) is a noninvasive method to assess vascular calcification. This study aimed to analyze the relationship between the activin A serum level and cIMT in patients with CKD at Mohammad Hoesin Hospital, Palembang, Indonesia. Methods. We conducted a hospital-based, cross-sectional study of consecutive CKD patients at the Department of Internal Medicine, Mohammad Hoesin Hospital, from July to November 2019. The level of activin A was measured by enzyme-linked immunosorbent assay. Meanwhile, cIMT measurements were collected by B-mode ultrasound imaging. Results. A total of 55 patients with CKD were included in this investigation. The median serum activin A level in these patients was 236.17 (116.33–283) pg/mL, while the median cIMT was 0.8 (0.6–1.45) mm. A relationship between the serum activin A level and cIMT (r = 0.449; p = 0.001 ) was observed. During multivariate analysis with linear regression, triglyceride p = 0.049 , phosphate p = 0.005 , and activin A p = 0.020 serum levels were factors associated with cIMT. Conclusion. In this study, a relationship between the activin A serum level and cIMT in patients with CKD was identified. Vascular calcification should be screened for in all CKD patients by the measurement of cIMT.

Pendahuluan. Penyakit kardiovaskular adalah penyebab kematian yang paling sering pada pasien penyakit ginjal kronik (PGK). Hal ini dibuktikan dengan ditemukannya kalsifikasi vaskular pada pasien PGK. Proses kalsifikasi vaskular yang terjadi sering dikaitkan dengan kondisi hiperparatiroid sekunder yang merupakan komplikasi dari pasien PGK. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar parathyroid hormone (PTH) serum dengan kalsifikasi aorta abdominal pada pasien PGK yang menjalani hemodialisis (HD). Metode. Penelitian observasional analitik uji korelasi dengan desain cross sectional yang dilakukan di ruang perawatan penyakit dalam RSUP dr. Mohammad Hoesin Palembang dari Juli hingga Desember 2019. Populasi penelitian adalah semua pasien PGK yang telah menjalani HD > 3 bulan dengan usia >18 tahun. Semua pasien dilakukan pemeriksaan kadar serum PTH dan dilakukan pengukuran derajat kalsifikasi aorta abdomen menggunakan lateral lumbal X-ray yang dihitung menggunakan skor Kauppila. Hasil . Dari 86 pasien HD yang diteliti, terdapat 65 pasien (75,6%) yang mempunyai kadar serum PTH yang tinggi dan 46 pasien (53,5%) yang mempunyai kalsifikasi pada aorta abdomen. Uji korelasi Spearman mendapatkan kadar serum PTH mempunyai hubungan dengan skor Kauppila (p=0,014, r=0,264). Analisis multivariat regresi linear mendapatkan usia (p 3 months with age > 18 years. All subjects were examined for serum PTH levels and measured the carotid artery wall using doppler ultrasonography and the degree of calcification of the abdominal aorta using a lateral lumbar X-ray which was calculated using the Kauppila score. Result s . There were 86 of HD patients studied , 65 subjects (75.6%) had high serum PTH levels and 46 subjects (53.5%) who had AAC. The Spearman correlation analysis showed that serum PTH levels had a relationship with Kauppila score (p=0.014, r=0.264). Multivariate linear regression analysis obtained age (p

Kidney disease affects 800 million children and adults worldwide, and the numbers keep increasing. A better understanding of the pathogenesis in kidney diseases, especially on a biomolecular level, is much needed to identify novel biomarkers and therapeutic targets for kidney diseases. The glomerular filtration barrier comprises endothelial cells, the glomerular basement membrane, and podocytes. The podocyte has a central role in part of the glomerular filtration barrier. The nor­mal functioning of podocytes is particularly important in preventing the heavy proteinuria seen in nephrotic syndrome or diabetic nephropathy, or in the disease process of focal segmental glomerulosclerosis. The podocyte is injured by circulating factors, which final­ly results in deranged podocyte motility. Soluble uro­kinase-type plasminogen activator receptor (suPAR) is a circulating form of glycosyl-phosphatidylinositol uPAR domain membrane protein and is known to play a role in the pathogenesis in kidney diseases, specifi­cally focal segmental glomerulosclerosis and diabetic nephropathy. suPAR binds to αvβ3 integrin on podo­cyte foot processes and causes podocyte structure dis­organization leading to glomerular filtration disruption and hence proteinuria. suPAR is also a potential bio­marker to predict the incidence of CKD.

Mortality in CKD patients undergoing hemodialysis considerably high. Previous study showed that mortality in patients undergoing hemodialysis was strongly correlated with chronic inflammation. The current study examined whether the serum c-reative protein concentration (hsCRP) changed from pre- to post-dialysis. In addition, the current study also investigated the correlation between dialysis age and hsCRP in chronic kidney disease patients undergoing hemodialysis. The study was a case-series study of 30 patients with hemodialysis. The patients were devided into three group based on dialysis age. Hemodialysis had been undergone for 4 hours, using hemoflow F8HPS, polysulfone synthetic dialysis membrane, and bicarbonate dialysis fluid. The primary outcome was serum concentration of high-sensitivity C-reactive protein (hsCRP), which was assessed in the pre-and-post dialysis, measured using chemiluminescent method. Dialysis does increased the hsCRP post-dialysis. It resulted in significant (p

Intradialytic hypertension and hypotension are both independently associated with increased morbidity and mortality among patients with chronic hemodialysis. Prior studies investigate the role of endothelial dysfunction in the mechanism of adverse intradialytic blood pressure changes. The aim of the current study was to investigate the association of plasma asymmetric dimethylarginine (ADMA), a marker for endothelial dysfunction, concentration changes pre-to-post-dialysis with both intradialytic hypertension and intradialytic hypotension. The study was a case-control study of 36 patients with chronic hemodialysis (12 patients in each group for intradialytic hypertension, intradialytic hypotension, and stable blood pressure). Intradialytic blood pressure changes were defined as increased or decreased systolic blood pressure pre-to-post-dialysis ≥10 mmHg in ≥4/6 consecutive HD sessions. Dialysis resulted in significant reduction of the plasma ADMA concentration pre-to-post dialysis in each group (0.26±0.15µmol/L, p=0.00 in patients with intradialytic hypertension; 0.18±0.15µmol/L, p=0.01 in patients with intradialytic hypotension; 0.17±0.09µmol/L, p=0.00 in patients with stable blood pressure). The reduction of plasma ADMA concentration in patients with intradialytic hypertension was significantly different compared to control group (p=0.02), albeit the insignificant difference in patients with intradialytic hypotension (p=0.78). Plasma ADMA concentration changes pre-to-post dialysis was considered as an insignificant risk factor (OR=1.96, 95%CI [0.38-9.93, p=0.41]) for intradialytic hypertension.