Symmetric dimethylarginine in hyperthyroid cats before and after treatment with radioactive iodine

Objectives The purpose of this study was to evaluate symmetric dimethylarginine (SDMA) in hyperthyroid cats before and after treatment with radioactive iodine and to determine how pretreatment SDMA relates to the development of post-treatment azotemia. Methods Eighty-four non-azotemic hyperthyroid cats had serum SDMA and creatinine evaluated before and 1, 3 and 6 months after treatment with radioiodine therapy. Results Baseline SDMA was increased in 7% (n = 6/84) of cats, whereas SDMA was increased in 19% (n = 15/81), 20% (n = 16/80) and 32% (n = 26/81) at 1 month, 3 months and 6 months after treatment, respectively. Creatinine was not elevated in any of the cats at baseline because of the study design, and was elevated in 6% (n = 5/81), 15% (n = 12/80) and 15% (n = 12/81) of cats at 1, 3 and 6 months after treatment, respectively. SDMA (median 11 mu g/dl, range 1-22 mu g/dl) was significantly higher at 3 (12 mu g/dl, range 6-45 mu g/dl; P = 0.005) and 6 months (11 mu g/dl, 6-25 mu g/dl; P <0.001) compared with baseline (11 mu g /dl, range 1-21 mu g/dl). The median baseline SDMA was significantly higher in the azotemic group (13 mu g/dl, range 11-22 mu g/dl) compared with the non-azotemic group (10 mu g/dl, range 1-21 mu g/dl, P = 0.002). The sensitivity of SDMA for detecting azotemia after treatment was 15.4%, with a specificity of 94.4%. Baseline serum SDMA concentration had a moderately positive association with baseline creatinine concentration (P <0.001, r = 0.437). At 6 months, there was a strong positive correlation between SDMA and creatinine concentrations (P <0.001, r = 0.721). There was no significant correlation with SDMA and thyroxine at baseline (P = 0.772, r = -0.034) or 6 months (P = 0.492, r = -0.078). Conclusions and relevance SDMA increases in cats treated for hyperthyroidism with radioactive iodine and likely reflects associated changes in glomerular filtration rate. An increased SDMA concentration above the reference interval prior to treatment has a high specificity but poor sensitivity for the prediction of post-treatment azotemia.