Abstract
l-carnitine is an important factor in fatty acid metabolism, and carnitine deficiency is common in dialysis patients. This study evaluated whether l-carnitine supplementation improved muscle spasm, cardiac function, and renal anemia in dialysis patients. Eighty Japanese outpatients (62 hemodialysis (HD) patients and 18 peritoneal dialysis (PD) patients) received oral l-carnitine (600 mg/day) for 12 months; the HD patients further received intravenous l-carnitine injections (1000 mg three times/week) for 12 months, amounting to 24 months of treatment. Muscle spasm incidence was assessed using a questionnaire, and cardiac function was assessed using echocardiography. Baseline free carnitine concentrations were relatively low in patients who underwent dialysis for >4 years. Total carnitine serum concentration, free carnitine, and acylcarnitine significantly increased after oral l-carnitine treatment for 12 months, and after intravenous l-carnitine injection. There was no significant improvement in muscle spasms, although decreased muscle cramping after l-carnitine treatment was reported by 31% of patients who had undergone HD for >4 years. Hemoglobin concentrations increased significantly at 12 and 24 months in the HD group. Therefore, l-carnitine may be effective for reducing muscle cramping and improving hemoglobin levels in dialysis patients, especially those who have been undergoing dialysis for >4 years.
Highlights
Previous studies have indicated that dialysis patients are predisposed to developing carnitine deficiency associated with skeletal muscle weakness, cardiomyopathy, heart failure, and renal anemia.a randomized controlled trial revealed that carnitine treatment was associated with a significantly improved survival rate among dialysis patients with dilated cardiomyopathy [1].These relationships may be because carnitine plays an important role in mitochondrial transport and long-chain fatty acid metabolism, contributing to energy production [2]
Dialysis patients may be predisposed to carnitine deficiency because of their protein-restricted diet, decreased l-carnitine production because of renal impairment, and increased carnitine loss during dialysis
We did not observe any significant improvement in muscle spasms after 12 months of treatment using oral l-carnitine, an improvement was reported by a subset of patients (31%) who had undergone dialysis for more than four years, and this proportion was substantially larger than the proportion among patients who had undergone dialysis for four years or less
Summary
Previous studies have indicated that dialysis patients are predisposed to developing carnitine deficiency associated with skeletal muscle weakness, cardiomyopathy, heart failure, and renal anemia.a randomized controlled trial revealed that carnitine treatment was associated with a significantly improved survival rate among dialysis patients with dilated cardiomyopathy [1].These relationships may be because carnitine plays an important role in mitochondrial transport and long-chain fatty acid metabolism, contributing to energy production [2]. Previous studies have indicated that dialysis patients are predisposed to developing carnitine deficiency associated with skeletal muscle weakness, cardiomyopathy, heart failure, and renal anemia. A randomized controlled trial revealed that carnitine treatment was associated with a significantly improved survival rate among dialysis patients with dilated cardiomyopathy [1]. These relationships may be because carnitine plays an important role in mitochondrial transport and long-chain fatty acid metabolism, contributing to energy production [2]. Serum carnitine concentrations tend to decrease at longer dialysis duration [3]. In this setting, carnitine deficiency may reduce fatty
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