Credit: Original article published here.In the population of patients with chronic kidney disease (CKD), particularly those with diabetes as the underlying cause of CKD, cardiovascular disease is a major cause of morbidity and mortality. While diabetic kidney disease (DKD) and cardiovascular disease have some risk factors in common, the pathogenesis of cardiovascular disease in the context of DKD is not completely understood, compounded by a lack of accurate biomarkers associated with cardiovascular outcomes in patients with DKD. Compared with the general population, the association between the traditional risk factors for cardiovascular disease (age, sex, diabetes, duration, total cholesterol, high-density lipoprotein cholesterol, smoking, systolic blood pressure, hypertensive therapy) is not as strong in patients with CKD. The uremic solutes trimethylamine-N-oxide (TMAO) and asymmetric and symmetric dimethylarginine (ADMA, SDMA) have been linked to cardiovascular disease in kidney failure with kidney replacement therapy (KFRT), but there are limited data in populations with diabetes and less severe kidney disease. Hima Sapa, PhD, and colleagues assayed plasma and urine for ADMA, SDMA, and TMAO in a random subcohort of participants with diabetes and baseline estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study.