Asymmetric Dimethylarginine & Symmetric Dimethylarginine (ADMA & SDMA)

ADMA and SDMA are natural byproducts of normal protein breakdown in your body. ADMA can block the production of nitric oxide, a molecule that helps keep blood vessels relaxed and healthy. When ADMA levels are too high, blood vessels may not work as well, which can raise the risk of heart and vascular problems. SDMA is mainly removed by the kidneys, so high SDMA levels can be a sign that the kidneys are not filtering as efficiently as they should. Your doctor may use these markers alongside other tests to get a fuller picture of your heart and kidney health.

When elevated: Elevated ADMA is associated with endothelial dysfunction, increased cardiovascular risk, hypertension, atherosclerosis progression, and adverse outcomes in heart failure and chronic kidney disease. Elevated SDMA primarily reflects reduced renal clearance and is associated with chronic kidney disease, acute kidney injury, and increased all-cause and cardiovascular mortality. Both elevations together may indicate compounded cardiorenal risk. When low: Low levels of ADMA and SDMA are generally not considered clinically significant in isolation and may reflect enhanced DDAH activity, robust renal function, or favorable metabolic status. Extremely low ADMA has been observed in some studies of liver failure due to impaired protein methylation, though this is not a primary clinical concern in routine practice.

ADMA and SDMA are emerging markers of endothelial health and vascular function—relevant to athletes because impaired nitric oxide availability can limit oxygen delivery, blood flow regulation, and exercise capacity. Elevated levels may reflect high training load, incomplete recovery, or subclinical cardiovascular strain, making these useful for monitoring training tolerance and long-term cardiovascular resilience rather than acute performance metrics.