Elevated plasminogen activator inhibitor 1 (PAI-1) has been associated with cardiovascular disease in hemodialysis patients. Carnitine, an amino acid-derived nutrient, is often decreased in hemodialysis patients and is associated with dilated cardiomyopathy and peripheral vascular dysfunction. The aim of this study was to determine a relationship between serum carnitine and PAI-1 levels and the composite cardiovascular end point (a history of angina, myocardial infarction, heart failure, stroke, peripheral vascular disease) in this predominantly African American patient population. We conducted a cross-sectional study involving 41 African American patients (14 M, 27 F; 60 ± 16 years) who were on hemodialysis $ 3 months. Patient demographics and medical histories were obtained. Predialysis serum PAI-1 (ELISA) and serum carnitine levels (spectrophotometry) were measured. Other markers of inflammation and oxidative stress, including C-reactive protein (CRP), IL-6, IL-10, and TNF-a, were also measured (ELISA). The subjects were divided into two groups: group 1 (n = 36) - low total serum carnitine (< 31 μmol/L for women and < 42 μmol/L for men) and group 2 (n = 5) - normal total serum carnitine ($ 31 μmol/L for women and $ 42 μmol/L for men). There were no significant differences in mean age (60 ± 16 years vs 64 ± 13 years; p = ns), gender, presence of hypertension or diabetes, etiology of CKD or serum levels of CRP, IL-6, IL-10, or TNF-a between the groups. PAI-1 levels were significantly higher in subjects in group 1 as compared to group 2 (62 ± 24 IU/mL vs 37 ± 21 IU/mL; p = .03). Nine subjects in group 1 had a composite cardiovascular end point as compared to none in group 2. In this population, patients with low carnitine levels had higher levels of PAI-1 as compared to patients with normal carnitine levels. This study was limited by small sample size and the high prevalence of low carnitine levels in hemodialysis patients. More studies are needed to further clarify this observation and the association with cardiovascular disease.
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