Abstract
L-carnitine is an essential compound that facilitates the transport of long-chain fatty acid across the inner mitochondrial membrane for β-oxidation. However, the effect of L-carnitine supplementation remains to be fully explored in patients with chronic kidney disease. We aimed in this study to determine the multidirectional effects of L-carnitine supplementation on clinical parameters in more detail. We orally administered L-carnitine to maintain serum-free carnitine levels within the normal range (30 to 70 μmol/L) for 6 months in 21 hemodialysis (HD) patients (age, 74 ± 11 years; time on HD, 60 ± 84 months). L-carnitine supplementation significantly increased serum transferrin from 155 ± 41 to 175 ± 48 mg/dL (p < 0.01) and retinol-binding protein from 8.9 ± 2.5 to 10.0 ± 3.4 mg/dL (p < 0.05). The triceps skinfold thickness was also significantly increased (p < 0.05), while the skeletal muscle mass in limbs and handgrip strength was not. L-carnitine enhanced natural killer (NK) cell activity at the E (effector cell)/T (target cell) ratio of 20:1 from 17.3 ± 14.1 to 20.8 ± 17.7 % (p < 0.01). In addition, L-carnitine improved left ventricular functional shortening (p < 0.01) with a significant decrease of brain natriuretic peptide (BNP) from 621.4 ± 666.8 to 412.0 ± 426.0 pg/mL (p < 0.05). These findings suggest that oral L-carnitine treatment improves immunological and cardiac markers in HD patients. In contrast, L-carnitine did not change the skeletal mass-related parameters during the 6-month follow-up.
Highlights
L-carnitine is an essential compound that facilitates the transport of long-chain fatty acid across the inner mitochondrial membrane for β-oxidation
L-carnitine supplementation We originally modified the initial dose of oral L-carnitine according to dry weight (DW) to maintain serum level within normal range without risk, since excess L-carnitine can be converted by intestinal microbiota into trimethylamine-N-oxide (TMAO), a potential promoter of coronary arteriosclerosis [6]
Basal characteristics During the follow-up, since we had lost five patients due to death (n = 4) and acute infection (n = 1), we analyzed a total of 21 patients
Summary
L-carnitine is an essential compound that facilitates the transport of long-chain fatty acid across the inner mitochondrial membrane for β-oxidation. The effect of L-carnitine supplementation remains to be fully explored in patients with chronic kidney disease. Protein-energy wasting (PEW) comprises excessive losses of body protein mass and energy reserves, and it is associated with high morbidity and mortality in patients with chronic kidney disease (CKD) [1]. L-carnitine is essential in Dialysis patients are especially at high risk for carnitine deficiency due to poor intake of sources of dietary carnitine such as red meat, reduced biosynthesis in the kidneys, and diffusive loss from the dialysate. In incident hemodialysis (HD) patients, the plasma carnitine level decreases within the first week of the treatment, with a. The carnitine content of the skeletal muscle decreases in hemodialysis patients and is inversely correlated with time on HD [4, 5]
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