Levocarnitine and Dialysis: A Review

Abstract

Among the various metabolic abnormalities documented in dialysis patients are abnormalities related to the metabolism of fatty acids. Aberrant fatty-acid metabolism has been associated with the promotion of free-radical production, insulin resistance, and cellular apoptosis. These processes have been identified as important contributors to the morbidity experienced by dialysis patients. There is evidence that levocarnitine supplementation can modify the deleterious effects of defective fatty-acid metabolism. Patients receiving hemodialysis and, to a lesser degree, peritoneal dialysis have been shown to be carnitine deficient, as manifested by reduced levels of plasma free carnitine and an increase in the acyl:free carnitine ratio. Cardiac and skeletal muscles are particularly dependent on fatty-acid metabolism for the generation of energy. A number of clinical abnormalities have been correlated with a low plasma carnitine status in dialysis patients. Clinical trials have examined the efficacy of levocarnitine therapy in a number of conditions common in dialysis patients, including skeletal-muscle weakness and fatigue, cardiomyopathy, dialysis-related hypotension, hyperlipidemia, and anemia poorly responsive to recombinant human erythropoietin therapy (rHuEPO). This review examines the evidence for carnitine deficiency in patients requiring dialysis, and documents the results of relevant clinical trials of levocarnitine therapy in this population. Consensus recommendations by expert panels are summarized and contrasted with present guidelines for access to levocarnitine therapy by dialysis patients.

Hemodynamic Stabilizing Effects of <smlcap>L</smlcap>-Carnitine in Chronic Hemodialysis Patients

“…Despite many trials, the results regarding the effects of L -carnitine supplementation on cardiac function of chronic hemodialysis patients are controversial [8,9,10,11]. Some authors noted an improvement [13,14,15,16,17], while others found no change [18,19,20].…”

“…Therefore, an improvement in cardiac function of patients with chronic hemodialysis associated with carnitine therapy might be expected. However, the results of previous studies are conflicting [8,9,10,11]. …”

“…Carnitine administration has been reported to be beneficial in patients with angina, ischemia-induced cardiac insufficiency, cardiogenic shock, cardiomyopathy and myocardial infarction [2]. …”

“…The concentration of plasma and tissue carnitine in chronic hemodialysis patients decreases severely because of its impaired synthesis in the kidney and liver, as well as due to great losses across the dialysis membrane during hemodialysis [2,3,4,5]. It has also been reported that hypocarnitinemia is closely related to cardiomegaly and cardiac ischemia in these patients [6,7].…”

Long-Term Effects of Oral <smlcap>L</smlcap>-Carnitine Supplementation on Anemia in Chronic Hemodialysis

“…The concentration of LC of chronic hemodialyzed patients in plasma and tissues decreased because of the impaired synthesis in kidney and liver and the great loss across the dialysis membrane during hemodialysis [3,4,5]. …”