L-carnitine supplementation and EPO requirement in children on chronic hemodialysis

Abstract

L-carnitine supplementation has been the subject of heated discussion in the context of the treatment of pediatric hemodialysis patients. The aim of this study was to analyze the effect of intravenous L-carnitine supplementation on the erythropoetin (EPO) requirement in six pediatric hemodialysis patients. All patients were on intravenous L-carnitine (2.5 g per session for patients >30 kg and 1 g for those <30 kg) for 9 months. The EPO dose was adapted monthly to maintain a target hemoglobin (Hb) level of 11-13 g/dl. Prior to the initiation of L-carnitine supplementation, the EPO requirement was 1.15 +/- 0.22 (range 0.37-1.75) microg/kg darbepoetin alpha. Free carnitine (FC) levels were measured before (40.4 +/- 4.9 micromol/l), immediately after the 9-month L-carnitine supplementation period (378.5 +/- 77.3 micromol/l), and 4 months after withdrawal of L-carnitine (95.6 +/- 4.0 micromol/l). After 9 months, the EPO dose was 0.47 +/- 0.10 microg/kg (p < 0.002). The Hb levels increased from 12.2 +/- 0.97 to 14.0 +/- 0.54 g/dl (p < 0.05) within the first 2 months, and the EPO dose was then decreased in a stepwise manner. In conclusion, following intravenous carnitine supplementation, FC levels were higher and persisted longer than expected. This rise was associated with increased Hb levels and decreased EPO requirement. Since controls were missing for this study, prospective long-term multi-center studies on a large number of patients are required to provide solid answers to the controversial question of L-carnitine supplementation in hemodialyzed children.

Pattern of resistance to erythropoietin-stimulating agents in chronic kidney disease

“…Consequently, its intravenous replenishment is associated with lower EPO requirement, lesser oxidative biomarkers, and positive nitrogen balance. [129][130][131] Long-acting EPO Concern for the adverse effects of excessive EPO has led to the synthesis of product with larger molecular weight and longer elimination half-life. Thus, a more efficient erythropoiesis (and lower side effects) is promoted by prevention of wide oscillation in biological activity that characterizes the short-acting variant.…”

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

“…5 Acorde a los resultados observados, los valores de hemoglobina no presentaron una mejoría a diferencia de los estudios por Aoun y sus colegas, 13 lo cual se puede explicar por el tamaño de muestra y por la duración de la suplementación que fue de 6 meses. Al realizar la comparación por proporciones y la medición de la reducción en el riesgo hubo una significancia clínica para la hemoglobina, lo cual es importante considerar, para ajustar los tiempos y un tamaño de muestra adecuado con estos hallazgos.…”

Carnitine for prevention of antituberculosis drug‐induced hepatotoxicity: A randomized, clinical trial

“…41,42 Many lines of evidence have pointed out the anti-oxidative characteristics of carnitine in different settings. [43][44][45][46] Role of carnitine in preventing renal tubular oxidative stress damage and ischemia/reperfusion injury have been reported through inhibition of oxidative damage and mitochondria dysfunction. 44 Carnitine also showed anti-oxidant effect similar to captopril on the heart of hypertensive rats.…”