Efficacy of L-carnitine supplementation for improving lean body mass and physical function in patients on hemodialysis: a randomized controlled trial

Maruyama, Takashi; Maruyama, Noriaki; Higuchi, Terumi; Nagura, Chinami; Takashima, Hiroyuki; Kitai, Maki; Utsunomiya, Kei; Tei, Ritsukou; Furukawa, T.; Yamazaki, Toshio; Okawa, Erina; Ando, Hisami; Kikuchi, Fumito; Abe, Masanori

doi:10.1038/s41430-018-0348-y

Cited by 22 publications

(18 citation statements)

References 36 publications

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“…Maruyama et al [16] reported that L-carnitine treatment reduced the required dose of ESAs in patients with a mean age of 70 ± 10 years having renal anemia on hemodialysis; it also maintained lean body mass and hand grip strength in hemodialysis patients [17]. We also evaluated the patients with similar age distribution, and although not significant, ERI was likely to decrease following L-carnitine treatment.…”

Section: Discussionmentioning

confidence: 88%

Effect of L-Carnitine on Amino Acid Metabolism in Elderly Patients Undergoing Regular Hemodialysis

et al. 2020

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Introduction: Among patients regularly undergoing hemodialysis, hypocarnitinaemia often develops as a consequence of inadequate dietary intake, reduced synthesis in the body, and considerable losses during hemodialysis. Objectives: To evaluate the effects of L-carnitine supplementation on patients with end-stage kidney disease (ESKD) who underwent hemodialysis. Methods: Thirty-one patients with ESKD, comprising 18 men and 13 women, with a median age of 72 (range 58-89) years, who underwent regular hemodialysis received treatment with L-carnitine for 1 year. The total and free carnitine, acylcarnitine, and amino acids (AA) levels before and after L-carnitine treatment were analyzed, and the blood biochemistry results and clinical profiles of the subjects were compared before and after treatment. Results: The median (interquartile range [IQR]) serum total and free carnitine and acylcarnitine levels significantly increased

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Section: Discussionmentioning

confidence: 88%

Effect of L-Carnitine on Amino Acid Metabolism in Elderly Patients Undergoing Regular Hemodialysis

et al. 2020

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“…However, there were no such results in the levocarnitine group. In addition, there were significant differences in the percent changes in arm muscle area, hand grip strength, and lean body mass after 12 months between the two groups [142]. Levocarnitine treatment was beneficial in patients on dialysis, particularly in elderly patients or those with diabetes, because it was able to maintain lean body mass and muscle function.…”

Section: Muscle Symptoms and Quality Of Lifementioning

confidence: 85%

“…Thereafter, all 14 patients were treated with levocarnitine for 10 months, with muscle strength increased in nine of the 14 patients. We previously conducted a randomized control trial of 91 hemodialysis patients who had lower serum carnitine levels [142]. The participants were randomly assigned to receive intravenous levocarnitine treatment (levocarnitine group) or no treatment (control group) for 12 months.…”

Section: Muscle Symptoms and Quality Of Lifementioning

confidence: 99%

Significance of Levocarnitine Treatment in Dialysis Patients

2021

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Carnitine is a naturally occurring amino acid derivative that is involved in the transport of long-chain fatty acids to the mitochondrial matrix. There, these substrates undergo β-oxidation, producing energy. The major sources of carnitine are dietary intake, although carnitine is also endogenously synthesized in the liver and kidney. However, in patients on dialysis, serum carnitine levels progressively fall due to restricted dietary intake and deprivation of endogenous synthesis in the kidney. Furthermore, serum-free carnitine is removed by hemodialysis treatment because the molecular weight of carnitine is small (161 Da) and its protein binding rates are very low. Therefore, the dialysis procedure is a major cause of carnitine deficiency in patients undergoing hemodialysis. This deficiency may contribute to several clinical disorders in such patients. Symptoms of dialysis-related carnitine deficiency include erythropoiesis-stimulating agent-resistant anemia, myopathy, muscle weakness, and intradialytic muscle cramps and hypotension. However, levocarnitine administration might replenish the free carnitine and help to increase carnitine levels in muscle. This article reviews the previous research into levocarnitine therapy in patients on maintenance dialysis for the treatment of renal anemia, cardiac dysfunction, dyslipidemia, and muscle and dialytic symptoms, and it examines the efficacy of the therapeutic approach and related issues.

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“…The clinical features include severe and persistent muscle cramps or hypotension during dialysis, low energy affecting quality of life, skeletal muscle weakness or myopathy, cardiomyopathy, and anemia of uremia unresponsive to or requiring large doses of ESA. Levocarnitine supplementation might improve cardiac function, brachial-ankle pulse wave velocity, ESA-resistant anemia, and maintenance of physical function in dialysis patients [25,26,27,28,29]. Levocarnitine supplementation may also cause symptomatic improvement due to carnitine deficiency in patients on PD as well as in patients on HD.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Peritoneal Dialysis

et al. 2019

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Background: Carnitine deficiency is common in patients on dialysis. Serum free carnitine concentration is significantly lower in patients on hemodialysis (HD) than in healthy individuals. However, there are few reports on serum free carnitine concentration in patients on peritoneal dialysis (PD). Methods: We examined serum concentrations of total, free, and acylcarnitine and the acylcarnitine/free carnitine ratio in 34 PD and 34 age-, sex-, and dialysis duration-matched HD patients. We investigated the prevalence of carnitine deficiency and clinical factors associated with carnitine deficiency in the PD group. Results: Prevalence of carnitine deficiency was 8.8% in the PD group and 17.7% in the HD group (p = 0.283). High risk of carnitine deficiency was found in 73.5% of the PD group and 76.4% of the HD group (p = 0.604). Carnitine insufficiency was found in 82.3% of the PD group and 88.2% of HD group (p = 0.733). Multivariate analysis revealed that duration of dialysis and age were independent predictors of serum free carnitine level in the PD group. Conclusions: The prevalence of carnitine deficiency, high risk of carnitine deficiency, and carnitine insufficiency in PD patients was 8.8%, 73.5%, and 82.3%, respectively. These rates were comparable to those in patients on HD.

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Efficacy of L-carnitine supplementation for improving lean body mass and physical function in patients on hemodialysis: a randomized controlled trial

Cited by 22 publications

References 36 publications

Effect of L-Carnitine on Amino Acid Metabolism in Elderly Patients Undergoing Regular Hemodialysis

Effect of L-Carnitine on Amino Acid Metabolism in Elderly Patients Undergoing Regular Hemodialysis

Significance of Levocarnitine Treatment in Dialysis Patients

Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Peritoneal Dialysis

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