L-Carnitine Supplementation Decreases the Left Ventricular Mass in Patients Undergoing Hemodialysis

Abstract

Background Patients on long-term hemodialysis become deficient in carnitine and are frequently treated with carnitine supplementation to offset their renal anemia, lipid abnormality and cardiac dysfunction. The therapeutic value of carnitine supplementation on left ventricular hypertrophy (LVH) in patients with normal cardiac systolic function remains uncertain. Methods and ResultsThe cardiac morphology and function of 10 patients given 10 mg/kg of L-carnitine orally, immediately after hemodialysis sessions 3 times per week for a 12-month period were compared with 10 untreated control patients. Using echocardiography, left ventricular fractional shortening (LVFS) and left ventricular mass index (LVMI) were measured before and after the study period. As a result, amounts of serum-free carnitine increased from 28.4±4.7 to 58.5±12.1 mol/L. The LVMI decreased significantly from 151.8±21.2 to 134.0±16.0 g/m 2 in treated patients (p<0.01), yet the LVMI in untreated control patients did not change significantly (ie, from 153.3±28.2 to 167.1±43.1 g/m 2 ). However, LVFS values remained unchanged in both groups. Although L-carnitine promoted a 31% reduction in erythropoietin requirements, hematocrit and blood pressure did not change during the study period. Conclusions Supplementation with L-carnitine induced regression of LVH in patients on hemodialysis, even for those with normal systolic function. (Circ J 2008; 72: 926 -931)

Effects of L-carnitine supplementation on nutritional, immunological, and cardiac parameters in hemodialysis patients: a pilot study

“…It has been reported that oral L-carnitine treatment significantly improved left ventricular function [26,27], while it reduced LVMI [28]. In this study, we confirmed that L-carnitine supplementation caused a significant increase in %FS concomitantly with a reduction of BNP.…”

“…In contrast, L-carnitine did not change LVMI. The reason for this discrepancy remains unknown, but it may be partly due to the shorter period of supplementation than in the previous study (12 months) [28].…”

Association Between Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Maintenance Hemodialysis Patients - Comparison With B-Type Natriuretic Peptide and Cardiac Troponin T -

“…Our present study suggests that patients with increased FGF-23 levels are likely to have LVH, which is the established principal risk factor driving the high rate of cardiovascular mortality in HD patients, and which may be reduced by L-carnitine supplementation. 24 In addition, we should emphasize that FGF-23 levels were associated with LVMI, irrespective of serum phosphate in our study. This finding is also consistent with the report by Gutierrez et al and Jean et al, who showed that an increased mortality in patients with elevated levels of FGF-23 was independent of serum phosphate levels.…”

Left Ventricular Mass in Chronic Kidney Disease and ESRD

“…Deficiency states, such as iron and/or erythropoietin (with attendant anemia), and perhaps carnitine deficiency as well can promote LVH (49). However, replacement of these factors have variable effects on LVH in CKD/ESRD (see below).…”