Effects of L-carnitine supplementation on muscular symptoms in hemodialyzed patients

Sakurauchi, Yasuhiro; Matsumoto, Y; Shinzato, Takahiro; Takai, Ichiro; Nakamura, Yutaka; Sato, Masashi; Nakai, Sadaaki; Misawa, Miwa; H, Morita; Miwa, Takashi; Amano, Izumi; Maeda, Kunimi

doi:10.1053/ajkd.1998.v32.pm9708610

Cited by 59 publications

(64 citation statements)

References 23 publications

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“…16 Such alteration may partly be reversed by exogenous administration of carnitine. 17 However, it is still controversial whether restoring plasma or tissue carnitine will correct the dyslipidemia, oxidative stress and impaired cardiac functions observed on maintenance HD.…”

Section: Discussionmentioning

confidence: 99%

“…Following two months of L-carnitine supplementation, a significant increase in the plasma FC level was observed in this study. Many researchers 16,17,18 have reported a correction in the depletion of FC by exogenous administration of L-carnitine for varying periods. Patients with CRF suffer from a secondary form of complex dyslipidemia consisting of both quantitative and qualitative abnormalities in serum lipoproteins resulting from alterations in lipoprotein metabolism and composition.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…All over the world, enormous populations are awaiting for relief from threatening of cramps in HD sessions. A number of palliative measures have been employed but not shown any consistent effects to date (Sakurauchi et al 1998;Khajehdehi et al 2001;Hinoshita et al 2003;Kobrin and Berns 2007;Hung et al 2009). The origin of this complication is likely multifactorial.…”

mentioning

confidence: 99%

Biotin Ameliorates Muscle Cramps of Hemodialysis Patients: A Prospective Trial

Oguma¹,

Ando

Hirose

et al. 2012

Tohoku J. Exp. Med.

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Patients with renal failure undergoing hemodialysis often have muscle cramps during and after the dialysis therapy. Muscle cramps are defined as the sudden onset of a prolonged involuntary muscle contraction accompanied with severe pain, resulting in early termination of a HD session and inadequate dialysis. The etiology of the cramps is unknown and effective anti-cramp medicine is not available. We have hypothesized that water-soluble vitamins are deficient in HD patients. Accordingly, we administrated biotin to 14 patients who had frequent muscle cramps during HD sessions. Oral administration of 1 mg/day biotin promptly reduced the onset and the severity of cramps in 12 patients both during and after HD. Then, the plasma biotin levels were measured by an enzyme-linked immunosorbent assay method (ELISA) in HD patients, including 14 patients with cramps and 13 patients without cramps, and 11 healthy volunteers. Plasma biotin levels were elevated in 27 HD patients at baseline compared with healthy volunteers [451 (377 -649) vs. 224 (148 -308) ng/l, median (lower-upper quartiles); p < 0.0001]. Unexpectedly, among the 14 cramp patients, the biotin levels were significantly higher in biotin-ineffective 7 patients than biotin-effective 7 patients [1,064 (710 -1,187) vs. 445 (359 -476) ng/l; p < 0.001]. Thus, the biotins measured by ELISA may consist of not only intact biotin but also its metabolites that do not function as a vitamin. In conclusion, biotin administration is one choice to relieve HD patients from muscle cramps regardless of their elevated plasma biotin levels.

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“…However, endogenous synthesis is altered by the dialysis of cofactors of carnitine synthesis, including vitamin B6, niacin, vitamin C, lysine, and methionine, and by protein malnutrition. Consequently, carnitine depletion develops rapidly after the start of hemodialysis and increases with duration of dialysis (3)(4)(5)(6). Additionally, free carnitine is dialyzed at a higher rate than is acyl-carnitine, and carnitine/acyl-carnitine translocase activity may decrease.…”

Section: Introductionmentioning

confidence: 99%

L-Carnitine Treatment in Incident Hemodialysis Patients

Mercadal

Coudert²,

Vassault³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground L-carnitine levels decrease rapidly and steadily with duration of hemodialysis, and carnitine depletion can impair response to recombinant human erythropoietin (rHuEPO). The study hypothesis was that L-carnitine supplementation during the first year of hemodialysis would improve this response.Design, setting, participants, & measurements From October 2006 through March 2010, this multicenter, randomized, double-blinded study assigned 92 incident hemodialysis patients to receive placebo or 1 g of intravenous L-carnitine after each dialysis session for 1 year. The primary outcome measure compared the groups for rHuEPO resistance index (EPO-RI), defined as weekly rHuEPO doses (IU/kg body weight divided by hemoglobin level) (g/dl). ResultsIn the L-carnitine group, carnitine concentration increased from a mean 6 SD of 79651 mmol/L to 2586137 mmol/L; in the placebo group, it declined from 68625 mmol/L to 53624 mmol/L (interaction group 3 time, P,0.001). Carnitine deficiency affected about 30% of the patients in the placebo group during the study period. EPO-RI varied from 15.8611.3 to 9.565.8 IU/kg per g/dl in the placebo group and from 20.6612.8 to 15.6615.9 IU/kg per g/dl in the L-carnitine group, for a mean variation of 23.94612.5 IU/kg per g/dl and 22.98615.5 IU/kg per g/dl, respectively (P=0.7). After adjustment for baseline characteristics, the EPO-RI course was similar in each group (difference between groups, P=0.10; interaction group 3 time, P=0.9).Conclusions Carnitine levels decrease by about 11%633% during the first year of hemodialysis. Treatment of incident hemodialysis patients with L-carnitine does not improve their response to rHuEPO.

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Effects of L-carnitine supplementation on muscular symptoms in hemodialyzed patients

Cited by 59 publications

References 23 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

Biotin Ameliorates Muscle Cramps of Hemodialysis Patients: A Prospective Trial

L-Carnitine Treatment in Incident Hemodialysis Patients

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