Lipid-lowering effect of carnitine in chronically uremic patients treated with maintenance hemodialysis

Abstract

Hypertriglyceridemia is often present in chronically uremic patients treated with maintenance hemodialysis and has been considered a risk factor in the accelerated development of atheroma. Muscle carnitine content is low in hemodialyzed patients. This abnormality may help to explain the myopathy and cardiomyopathy often observed in these subjects. In addition, carnitine might play a role in the hypertriglyceridemia in renal failure. Carnitine, which is necessary for fatty acid oxidation, has been recently reported to lower serum triglycerides in patients with type IV hyperlipoproteinemia. Carnitine was administered intravenously three times weekly at the end of hemodialysis in eight patients. Carnitine was given in 0.5 g doses for 8 weeks and then in 1.0 g doses for 6 additional weeks. There was a significant decrease in serum triglycerides at the end of treatment. In contrast, serum lipids in eight hemodialysis patients receiving placebo did not change significantly. Carnitine administration does not cause any side effect except some euphoria. These results suggest that carnitine may be effective in the treatment of hypertriglyceridemia in dialysis patients.

Genomic interval engineering of mice identifies a novel modulator of triglyceride production

“…This facilitated the discovery of a novel and previously unappreciated aspect of the carnitine-deficient phenotype: the relationship between carnitine, hepatic triglyceride production, and OCTN2. The findings of the present study, coupled with reports of carnitine administration significantly reducing plasma triglyceride concentrations in hypertriglyceridemic hemodialysis patients (29,30) as well as in patients with type IV hyperlipoproteinemia (31), provides genetic evidence in support of a critical role for carnitine transport in the regulation of plasma triglyceride metabolism. The analysis of the del 11 ͞del 11 as well as the del 11 ͞ϩ mice suggest that reductions in carnitine, whose intracellular concentration appears to be affected by modest decreases in OCTN2 activity, leads to the shunting of fatty acids away from mitochondrial transport into triglyceride storage and secretory pools.…”

Effects ofL-Carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients

“…This result is in agreement with previous studies. 18,21,22 Hypercoagulability has been reported to occur frequently in dialysis patients. [3][4][5] This is due to increased plasma concentrations of fibrinogen, PAI-1, PAI-1 to tPA ratio, and the activity of coagulation factor VII, and decreased plasma tPA concentration and the activity of protein C. [4][5][6][7][8][9][10][11][12][13][14] Hypercoagulability is a major cause of complications in hemodialysis patients, leading not only to possibly fatal complications such as ischemic heart disease or stroke, but also to thrombus formation in arteriovenous fistulas.…”

Carnitine depletion as a probable cause of hyperlipidemia in uremic patients on maintenance hemodialysis.

“…Recently an increasing attention has been focused on carnitine metabolism as a potential association with hyperlipidemia in uremic patients on maintenance hemodialysis (Bohmer et al 1978;Bougneres et al 1979;Giarnieri et al 1980;Lacour et al 1980). Hemodialysis treatment causes the loss of large amounts of carnitine from blood and tissues into the dialysate fluid.…”