Carnitine Abnormalities in Patients with Renal Insufficiency

Wanner, Christoph; Hörl, Walter H.

doi:10.1159/000185137

Cited by 90 publications

(48 citation statements)

References 63 publications

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“…Elimination of FC during hemodialysis with a rapid decrease of serum carnitine level to 40% of baseline level during the dialysis session has been reported. 18 Other investigators also 19,20 reported elimination of FC during hemodialysis. Following two months of L-carnitine supplementation, a significant increase in the plasma FC level was observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Dyslipidemia, Oxidative Stress and Cardiac Dysfunction in Children with Chronic Renal Failure: Effects of L-Carnitine Supplementation

2003

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Background: Secondary carnitine deficiency may develop in chronic renal failure (CRF) patients undergoing longterm hemodialysis (HD), with a resulting higher incidence of cardiovascular diseases, dyslipidemia and oxidative stress. We studied the efficacy of 12 months of L-carnitine supplementation on the amelioration of dyslipidemia, oxidative stress and cardiac dysfunction in 24 CRF children undergoing long-term HD compared with 24 age-and sex-matched controls. Methods: Plasma samples were analyzed spectrophotometerically before and after dialysis sessions and after 2-month supplementation with oral L-carnitine (50 mg/kg/day) for free carnitine (FC), the lipid profile, and oxidative stress markers. Echocardiography the day following dialysis measured cardiac diameters, wall thicknesses, left ventricular mass index (Ml), end diastole and systole volume indices and functions. Results: The pre-dialysis FC concentration was substantially lower than controls and decreased significantly at the end of the dialysis session. Pre-and post-dialysis plasma levels of free fatty acids (FFAs), trigyleride (TG), total cholesterol (TC) and oxidative stress markers significantly increased while high-density lipoprotein cholesterol (HDL-C) and phospholipids significantly decreased compared to controls. Echocardiography detected a significant increase in cardiac diameters and thickness, and systolic and diastolic cardiac dysfunction. After L-carnitine supplementation, plasma levels of FC increased to normal levels. FFAs, TC and HDL-C returned to control levels while TG, phospholipids, and the oxidative stress markers decreased but remained significantly higher than controls. There was a significant decrease in cardiac diameters and an increase in left ventricular diastolic function (E/A ratio), but no correlation between FC levels and echocardiographic parameters. Pre-dialysis, post-dialysis and after treatment, plasma FC level showed a significant positive correlation with HDL-C and phospholipids and a significant negative correlation with each of oxidative stress markers, FFAs, TG and TC. On the other hand, FFAs showed a significant positive correlation with TG, TC, DC, NO and a significant negative correlation with HDL-C and phospholipids. Conclusion: This study demonstrates that CRF children under regular HD suffer from a decrease in the level of plasma FC, dyslipidemia, oxidative stress, and an increase in cardiac diameters and thickness with impairment of cardiac functions. Oral L-carnitine supplementation at a dose of 50 mg/kg for 2 months can increase plasma FC level, improve dyslipidemia, decrease oxidative stress with reduction of cardiac diameters and increase in diastolic function.

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Section: Discussionmentioning

confidence: 99%

Dyslipidemia, Oxidative Stress and Cardiac Dysfunction in Children with Chronic Renal Failure: Effects of L-Carnitine Supplementation

2003

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“…12,13,20 It has been widely established that long-term haemodialysis treatment results in alterations in the endogenous carnitine pool, with a large number of studies reporting signi¢cantly lower plasma endogenous L-carnitine concentrations in haemodialysis patients compared with healthy individuals. 4--21 Despite signi¢-cant reductions in L-carnitine concentrations in the haemodialysis population, total carnitine concentrations remain relatively unchanged.…”

Section: Discussionmentioning

confidence: 99%

Impact of haemodialysis on individual endogenous plasma acylcarnitine concentrations in end-stage renal disease

et al. 2005

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Background Patients with end-stage renal disease (ESRD) undergoing long-term haemodialysis exhibit low L-carnitine and elevated acylcarnitine concentrations. This study evaluated endogenous concentrations of an array of acylcarnitines (carbon chain length up to 18) in healthy individuals and ESRD patients receiving haemodialysis, and examined the impact of a single haemodialysis session on acylcarnitine concentrations.

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“…The marked deficiency in serum FC at 3 and 6 wk (Figures 2 and 3) most probably is related to the degree of renal dysfunction, because dietary and dialytic losses of carnitine have not played a role here. Under normal conditions, more than Ͼ90% of the filtered carnitine is reabsorbed (29), with FC being preferentially reabsorbed, resulting in four to eight times higher urinary excretion of carnitine esters (30). Thus, a deterioration in renal function is associated with decreased carnitine clearance and impaired excretion of AC.…”

Section: Uremia and Carnitinementioning

confidence: 99%

Myocardial Function, Energy Provision, and Carnitine Deficiency in Experimental Uremia

Reddy

Bhandari

Seymour

2007

Journal of the American Society of Nephrology

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Cardiac complications are the leading cause of mortality in patients with chronic renal failure. Secondary carnitine deficiency, which is frequently observed in hemodialysis patients, has been associated with cardiac hypertrophy and heart failure and may impair myocardial fatty acid oxidation. In chronic kidney disease, impaired carnitine homeostasis also may affect myocardial metabolism. In this study, myocardial function and substrate oxidation in conjunction with carnitine deficiency were investigated in experimental renal failure. Uremia was induced in male Sprague-Dawley rats via a two-stage five-sixths nephrectomy. Cardiac function and substrate oxidation were assessed in vitro by means of isovolumic perfusion using 13 C nuclear magnetic resonance at 3 and 6 wk of uremia. Renal impairment as assessed by serum creatinine was more severe initially and was associated with a significant deficiency in serum free carnitine (43%; P < 0.001) and elevated acyl carnitine/free carnitine ratio. Myocardial tissue carnitine concentrations, however, were unaffected. A moderate degree of cardiac hypertrophy (10 to 14%; P < 0.05) was observed in uremia without evidence of dysfunction or changes in myocardial substrate utilization. It is concluded that renal dysfunction is associated with cardiac hypertrophy in the presence of normal myocardial carnitine levels, despite a significant depletion in serum carnitine. This may be a factor in maintaining normal cardiac function and metabolism.

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Carnitine Abnormalities in Patients with Renal Insufficiency

Cited by 90 publications

References 63 publications

Dyslipidemia, Oxidative Stress and Cardiac Dysfunction in Children with Chronic Renal Failure: Effects of L-Carnitine Supplementation

Dyslipidemia, Oxidative Stress and Cardiac Dysfunction in Children with Chronic Renal Failure: Effects of L-Carnitine Supplementation

Impact of haemodialysis on individual endogenous plasma acylcarnitine concentrations in end-stage renal disease

Myocardial Function, Energy Provision, and Carnitine Deficiency in Experimental Uremia

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