Clinical significance of different carnitine levels for improving the prognosis of patients undergoing hemodialysis

Abstract

Objective: To investigate plasma-free carnitine (Fc), acylcarnitine (Ac), and total carnitine (Tc) levels in patients undergoing hemodialysis (HD), and to explore their clinical significance. Methods: A total of 20 subjects were in the normal control group and 133 patients undergoing HD were divided into medicated (received carnitine treatment) and non-medicated groups. The medicated group was further divided into three subgroups according to Fc level: , and ! 300 lmol/L. We used non-derivative tandem mass spectrometry to determine carnitine levels, and clinical symptoms such as weakness, hypotension, and muscle cramps were recorded during dialysis. Results: Fc and Tc levels were significantly lower in the non-medicated group than in the control group, whereas Fc, Ac, and Tc levels were higher in the medicated than non-medicated group (p< .05). The medicated group had fewer symptoms during dialysis than the non-medicated group such as weakness, hypotension, and muscle cramps (p< .05). An additional comparison showed that the incidence rates of hypotension and muscle cramps in the Fc < 80-199 lmol/L group were significantly lower than those in the Fc ! 300 lmol/L medicated and non-medicated groups. Conclusions: Patients undergoing HD have low carnitine levels. L-Carnitine can effectively increase Fc concentration and improve clinical symptoms; however, only the proper Fc range can reduce complications caused by dialysis. Thus, this range needs to be determined. ARTICLE HISTORY

Hemodiyaliz Hastalarında Karnitin Kullanımı

“…Bu semptomlar üremik toksisitenin neden olduğu tablo ile sıklıkla karıştırılmasına rağmen plazma karnitin seviyesinin takibi tanı için önemlidir (20).…”

“…Aynı zamanda hipotansiyon ve kas krampları insidansı serbest karnitin seviyesi 80-199 µmol/L olan grupta, karnitin desteği almayan ve serbest karnitin seviyesi >̲300 µmol/L olan gruba göre daha düşük bulunmuştur (p<0,05). Bu durum karnitin desteğinin HD sırasındaki semptomları iyileştirici etkisi yanında uygun karnitin seviyesinin de önemli olduğunu vurgulamaktadır (20).…”

Hepcidin and its Related Hematological Biomarkers of Anemia in Children on Hemodialysis: Role of Carnitine Deficiency

“…Carnitine is an essential aminoacid derivative having vital roles in fatty-acid metabolism in cardiac muscle and skeletal muscle [18]. Carnitine is present in two forms in the body, acylcarnitine, and free carnitine, and the sum of them is defined as total carnitine [19]. Free carnitine binds to an acyl residue and converted to acylcarnitine.…”

“…The nutritional status of HD patients is positively affected by carnitine by enhancing a positive protein balance, and by reducing insulin resistance and chronic inflammation [18]. Carnitine is vital for RBCs to perform their metabolic function in renal anemia [19] that can have a negative impact on erythrocyte production and survival [20]. Carnitine deficiency is reported to be associated with several pathological conditions, including cardiac dysfunction, muscle weakness and anemia.…”

Role and Location of L-Carnitine in Cytoprotection and Correction of Metabolic Processes in Patients With Metabolic Syndrome

“…Пероральный прием L-карнитина (750 мг/день) улучшает липидный профиль у пациентов на гемодиализе [70]. В сравнительном исследо-вании [71] у пациентов, принимавших L-карнитин, досто-верно реже отмечались такие сопутствующие симптомы, как слабость, гипотония и мышечные судороги (р <0,05). В другом исследовании пероральный прием L-карнитина пациентами, получающими гемодиализ, улучшал не толь-ко ощущения мышечного дискомфорта, но также сопут-ствующие желудочно-кишечные расстройства и наруше-ния кишечного микробиоценоза [72].…”