Significance of Levocarnitine Treatment in Dialysis Patients

Abstract

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.

The Role of l-Carnitine in Mitochondria, Prevention of Metabolic Inflexibility and Disease Initiation

“…Fatty acid metabolism LC transports LCFA across inner mitochondrial membrane for subsequent beta oxidation and ATP production [4,5] Regulation of mitochondrial acetyl-CoA/CoA ratio and acyl-CoA/CoA ratio LC forms an effective transport system for acetyl or acyl groups out of the mitochondria to maintain free CoA levels important for glycolysis and other processes [2,5] Detoxification of potentially toxic metabolite LC binds acyl residues and helps in their elimination thereby maintaining metabolic flexibility [7] Stabilization of cell membranes LC helps stabilize cell membranes via its effects on acetylation of membrane phospholipids and surface membrane effects [8,9] Table 1. Cont.…”

“…New research suggests that it also participates in blood glucose homeostasis [ 3 ]. l -carnitine continues to receive scientific attention as a therapy for kidney disease, cardiovascular disease, and diabetes, as well as symptoms associated with carnitine deficiency and mitochondrial disorders [ 4 , 5 , 6 ].…”

Change in Anemia by Carnitine Supplementation in Patients Undergoing Peritoneal Dialysis: A Retrospective Observational Study

“…Carnitine is a water-soluble amino acid derivative with a molecular weight of 161 Da, and it has an important role in fatty acid metabolism in skeletal muscle (1)(2)(3). Seventy-five percent of the human body requirement for carnitine is obtained from the diet such as red meat, while the remaining 25% is biosynthesized in the kidneys and liver (4,5).…”

Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life

“…In CKD and HD patients, the deficiency of certain micronutrients such as carnitine [ 9 ] and zinc [ 10 ] is often observed and involved in pathological conditions. Therefore, levocarnitine administration and zinc supplementation may be reasonable therapeutic approaches [ 9 , 10 ].…”

“…In CKD and HD patients, the deficiency of certain micronutrients such as carnitine [ 9 ] and zinc [ 10 ] is often observed and involved in pathological conditions. Therefore, levocarnitine administration and zinc supplementation may be reasonable therapeutic approaches [ 9 , 10 ]. Although the cause of appetite loss is largely unknown in HD patients, a fundamental solution may be an increased food intake in HD patients.…”