Effect of L-Carnitine Supplementation on Red Blood Cells Deformability in Hemodialysis Patients

Abstract

Anemia is a serious problem in hemodialysis patients, the main cause of which is erythropoietin deficiency. After the discovery of recombinant human erythropoietin (rHuEpo) at the end of the last decade, the hematological profile of hemodialysis patients improved significantly but at considerable expense. The deformability of red blood cells (RBC) influences their microcirculation and tissue oxygen delivery along with their life span. We investigated the deformabilty of RBCs in 15 hemodialysis patients before and after three months on L-carnitine supplementation (30 mg/Kg body wt/dialysis session). We excluded from the study all patients who received blood transfusions three months before or during the study, patients who had hemorrhagic episodes, those with hyperparathyroidism or infections, and any who required surgical intervention during the study. The serum iron, folic acid and vitamin B-12 levels were kept normal during the duration of the study. The erythropoietin dose taken before the beginning of L-cartnitine supplementation was not changed. The deformability of RBCs before and after dialysis, prior to and following three months on L-carnitine was determined and compared to the deformability of RBCs from a control group. Hematocrit levels were measured before entry into the study and every month for three months. We found that the deformability of RBCs before the dialysis session was significantly greater than that found in the control group (t-test, p < 0.00001), and that there was a further increase after the end of the dialysis session. Three months following L-carnitine supplementation, we found a significant reduction of RBCs deformability (paired t-test, p < 0.004), and a significant increase in the hematocrit (ANOVA, p < 0.0001). We concluded that abnormalities in the deformability of RBCs improved after L-carnitine and that this was responsible for the increase in the hematocrit. This may allow a substantial reduction in rHuEpo dose.

Beneficios de la suplementación con L-carnitina en pacientes pediátricos hemodializados. Reporte de casos

“…Por otro lado, Lilien y su equipo 14 tampoco encontraron una diferencia significativa en los niveles de hemoglobina ni una reducción en la dosis de eritropoyetina, lo cual coincide en este estudio; sin embargo, es pertinente mencionar que se pensó que se podrían obtener resultados favorables, ya que la vía de suplementación de la L-carnitina en el estudio de Lilien y su grupo 14 fue vía oral, y en nuestro estudio fue vía intravenosa, cuya farmacocinética es mejor acorde a la biodisponibilidad y estabilidad en la absorción, 15 lo cual se pudo comprobar al hacer el cálculo por proporciones para los casos y se pudieron detectar mejorías para hemoglobina después de la maniobra con incremento de 0.1 a 2.9 g/dL, lo cual refleja un beneficio con la suplementación.…”

Long-term L-Carnitine Administration reduces Erythropoietin Resistance in Chronic Hemodialysis Patients with Thalassemia Minor

“…It can be hypothesized that in β-thal on dialysis only the long-term carnitine administration improves the strictness of RBC, and conversely enhances the cell half-life. Indeed, other Authors showed that abnormalities in RBC deformability improves after carnitine administration, which is also responsible for hematocrit increase and EPO dose reduction (33). In this study, the EPO dose reduced from 280 to 170 UI/kg/day (−39%) at the 12th month of treatment in thal, and all patients were responders (EPO reduction range: −29 to −45%).…”

Is there a Role for Oral L-Carnitine Therapy in Anemia and Cardiac Dysfunction Management in Egyptian Patients on Maintenance Hemodialysis?

“…Also, Nikolaos et al (19) showed that 3 months of treatment with L-carnitine (30 m/kg for dialysis session) significantly reduces the deformability of red blood cells and significantly increases hematocrit.…”

“…The salutary effects of L-carnitine on anemia center on improvement of erythrocyte survival, specifically through enhanced erythrocyte membrane stability (19,26,27).…”