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Abstract: FR-PO434

Trimethylamine N-Oxide and Cardiovascular Outcomes in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Zhang, Pan, Division of Nephrology, Zhongshan Hospital, FuDan University, Shanghai, China

Group or Team Name

  • Division of Nephrology, Zhongshan Hospital, FuDan University,; Shanghai Institute of Kidney Disease and Dialysis; Shanghai Key Laboratory of Kidney Disease and Blood Purification, Shanghai, China.

Trimethylamine-N-Oxide (TMAO) has a definite role in promoting atherosclerosis, which is an independent risk factor of cardiovascular disease. Cardiovascular disease is the leading cause of death in hemodialysis patients. The plasma level of TMAO in hemodialysis patients increases significantly, which is more than 20 times over the non-dialysis patients, but the relationship between TMAO and the cardiovascular outcomes in hemodialysis patients has not been well defined.


A prospective cohort study design was adopted. 252 patients who were eligible for the inclusion criteria were enrolled, and baseline clinical data were collected. Then these patients were followed for 9 years, the primary endpoints were all-cause and cardiovascular death, and the secondary endpoints were cerebrovascular death. The plasma TMAO concentration was determined, the Kaplan-Meier method and Cox proportional risk model were used to analyze the relationship between TMAO concentration and cardiovascular mortality and all-cause mortality.


Median follow-up was 73.4 (42.9-108) months. During the follow-up, there were 123 cases of death totally, among them 39 cases of cardiovascular death, 19 cases of cerebrovascular death, 65 cases of other causes death. 20 cases transferred to other dialysis centers, and 15 cases received kidney transplantation. The median plasma TMAO concentration was 63.1μmol/L. Based on the median concentration of TMAO, the patients were categorized as High TMAO group (TMAO > 63.1μmol/L) and Low TMAO group (TMAO ≤ 63.1μmol/L). Kaplan-Meier analysis found that the incidences of all-cause death (Log-Rank P < 0.001) and cardiovascular death (Log-Rank P = 0.006) in High TMAO group were significantly higher than those of Low TMAO group. Multivariate Cox regression demonstrated that plasma TMAO was significantly associated with all-cause death (TMAO as continuous variable:HR 1.123, 95%CI(1.067-1.183), P < 0.001; TMAO as dichotomous variable:HR 2.147, 95%CI(2.149-3.117), P < 0.001) and cardiovascular death (TMAO as continuous varible:HR 1.126, 95%CI(1.027-1.235), P = 0.011; TMAO as dichotomous variable: HR 2.517, 95%CI(1.275-4.969), P = 0.008). After adjustment of conventional and non-conventional risk factors, the relationship of plasma TMAO and all-cause and cardiovascular death remained significant.


Plasma TMAO is an independent risk factor of cardiovascular outcomes in hemodialysis patients.


  • Government Support - Non-U.S.