Effect of <i>L</i>-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients

Abstract

It has been reported that cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response. We undertook the present study to determine if there is any hypolipidemic effect of L-carnitine on Greek dialysis patients in concert with the dialysate buffer composition (acetate or bicarbonate). A total of 28 patients (16 male, 12 female), mean age 43 years (range 21–61), with end-stage renal disease on maintenance hemodialysis for a mean period of 25 months (range 7–84) were studied. The dialysis schedule was 4 h, 3 times/week using cuprophane hollow-fiber dialyzers and acetate (n = 14) or bicarbonate (n = 14) dialysate. In all patients L-carnitine (5 mg/kg body weight) was infused intravenously 3 times/week at the end of each hemodialysis session. Blood samples for carnitine and lipid determinations were obtained before treatment, and 3 and 6 months following treatment. Even though L-carnitine did not modify most of the serum lipid levels, a significant decrease in serum triglycerides was evident in the whole group of patients (from 225 ± 76 to 201 ± 75 mg/dl, p = 0.03). Furthermore, L-carnitine could decrease serum triglycerides only in hypertriglyceridemic patients (from 260 ± 64 to 226 ± 82 mg/dl, p < 0.05). L-Carnitine resulted in a reduction of serum triglycerides in both patients on bicarbonate and on acetate dialysis, while there were no significant differences in the changes of lipid parameters after L-carnitine between the two groups of hemodialysis patients. We conclude that relatively low doses of L-carnitine supplementation could contribute to the management of some hypertriglyceridemic hemodialysis patients.

Carnitine supplementation improves apolipoprotein B levels in pediatric peritoneal dialysis patients

“…There are conflicting reports of apo B levels in HD patients. In addition to non-significant changes [37,38,39,40], decreased levels [41] have been noted, similar to our findings. Since no change was observed in the apo B-containing lipoprotein levels, the decrease in apo B levels cannot be explained with an increase in catabolism of lipoproteins.…”

Genomic interval engineering of mice identifies a novel modulator of triglyceride production

“…This facilitated the discovery of a novel and previously unappreciated aspect of the carnitine-deficient phenotype: the relationship between carnitine, hepatic triglyceride production, and OCTN2. The findings of the present study, coupled with reports of carnitine administration significantly reducing plasma triglyceride concentrations in hypertriglyceridemic hemodialysis patients (29,30) as well as in patients with type IV hyperlipoproteinemia (31), provides genetic evidence in support of a critical role for carnitine transport in the regulation of plasma triglyceride metabolism. The analysis of the del 11 ͞del 11 as well as the del 11 ͞ϩ mice suggest that reductions in carnitine, whose intracellular concentration appears to be affected by modest decreases in OCTN2 activity, leads to the shunting of fatty acids away from mitochondrial transport into triglyceride storage and secretory pools.…”

Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

“…This result is in agreement with previous studies. 18,21,22 Hypercoagulability has been reported to occur frequently in dialysis patients. [3][4][5] This is due to increased plasma concentrations of fibrinogen, PAI-1, PAI-1 to tPA ratio, and the activity of coagulation factor VII, and decreased plasma tPA concentration and the activity of protein C. [4][5][6][7][8][9][10][11][12][13][14] Hypercoagulability is a major cause of complications in hemodialysis patients, leading not only to possibly fatal complications such as ischemic heart disease or stroke, but also to thrombus formation in arteriovenous fistulas.…”