Abstract
Aim: L-carnitine is a short organic hydrosoluble molecule and is present in biological materials like free carnitine and acylcarnitines, which constitute the carnitine system. Long-term intermittent hemodialysis is associated with a reduction in plasma and tissue L-carnitine levels. Available studies on carnitine supplementation suggest the use of this molecule in dialysis, especially for those patients with cardiac complications, impaired exercise and functional capacities, and increased episodes of hypotension. Moreover, in some patients, the improved stability of erythrocyte membranes with L-carnitine supplementation may decrease erythropoietin requirements, thus leading to a reduction of dialytic costs. To study if there a possible advantageous effects for L– carnitine oral supplementation in anemia and cardiac dysfunction management in a cohort of Egyptian patients on maintenance hemodialysis. Methods: Fifty-five patients with chronic renal failure on maintenance hemodialysis were classified into 2 groups: L-carnitine group: 20 patients (12 male and 8 female, mean age 47.66±17.73 years, hemodialysis duration 51.36±18.14 months, subjected to three sessions/week reaching a Kt/V of 1.49±0.37) they received oral L-carnitine therapy 1.500 mg/day and control group: 35 patients (24 male and 11 female, mean age 37.9±14.7 years, hemodialysis duration 53.83±15.17 months, subjected to three sessions/week reaching Kt/V of 1.33±0.23). Both groups were on Erythropoietin therapy and IV iron whenever indicated. Echogardiographic studies were performed before and at the end of the study. Results: Serum hemoglobin were comparable in the L-carnitine group and control group at the start and six months after therapy (8.63±1.77 and 9.39±2.02 gm/dl, p= 0.18, 10.49±1.65 and 10.92±2.48 gm/dL p= 0.76 respectively). The weekly maintenance dose of Erythropoietin in spite of being lower in L-carnitine group (80.16±35.61 units/kg) compared to control group (91.9±38.21 units/kg) it does not reach a statistical significance (p= 0.20). No significant improvement could be observed in echogardiographic findings in the L-carnitine group after therapy. Conclusion: The role of L-carnitine in hemodialysis patients is questionable. Our study revealed no observed significant improvement in echocardiographic findings 6 months after therapy. However, -a statistically non significant-reduction in Erythropoietin dose was achieved in the L-carnitine-treated compared to the control group while maintaining comparable target hemoglobin in both groups. Long-term studies including larger number of patients are required to clarify its role in hemodialysis patients.
Highlights
Carnitine (3-hydroxi-4-N-trimethylammoniobutanoate) is a short organic hydrosoluble molecule and is present in biological materials like free carnitine and acylcarnitines, which constitute the carnitine system.In humans, carnitine plays a pivotal role in energy metabolism through the transportation of long-chain fatty acids across the inner mitochondrial membrane and controlling the rates of beta oxidations of long-chain fatty acids with subsequent energy production [1].The endogenous plasma levels of L-carnitine in the healthy human (L-carnitine + acylcarnitines) are 40–50 mmol/L; acetyl-L-carnitine levels are usually 3–6 mmol/L
Fifty-five patients with chronic renal failure on maintenance hemodialysis were classified into 2 groups: L-carnitine group: 20 patients (12 male and 8 female, mean age 47.66±17.73 years, hemodialysis duration 51.36±18.14 months, subjected to three sessions/week reaching a Kt/V of 1.49±0.37) they received oral L-carnitine therapy 1.500 mg/day and control group: 35 patients (24 male and 11 female, mean age 37.9±14.7 years, hemodialysis duration 53.83±15.17 months, subjected to three sessions/week reaching Kt/V of 1.33±0.23)
Serum hemoglobin were comparable in the L-carnitine group and control group at the start and six months after therapy (8.63±1.77 and 9.39±2.02 gm/dl, p= 0.18, 10.49±1.65 and 10.92±2.48 gm/dL p= 0.76 respectively)
Summary
Carnitine (3-hydroxi-4-N-trimethylammoniobutanoate) is a short organic hydrosoluble molecule and is present in biological materials like free carnitine and acylcarnitines, which constitute the carnitine system. The endogenous plasma levels of L-carnitine in the healthy human (L-carnitine + acylcarnitines) are 40–50 mmol/L; acetyl-L-carnitine (the most abundant acylcarnitine) levels are usually 3–6 mmol/L. Plasma carnitine only account for approximately 1% of the total body carnitine pool, with over 98% of carnitines present in the skeletal and cardiac muscles. Plasma concentration of free carnitine is in dynamic balance with that of acylcarnitines, and the acyl to free carnitine ratio is considered normal when it is ≤0.4.HD involves carnitine as one of the solutes capable of crossing the dialyzer membrane through osmosis. Dialysis therapy in uremic patients determines a decrease in both free carnitine and plasmatic acylcarnitines after only 6 months of dialysis treatment [4]
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