The Unexpected Effects of L-Carnitine Supplementation on Lipid Metabolism in Hemodialysis Patients

Abstract

Background/Aims: There is a growing body of evidence that the long-term hemodialysis (HD) treatment leads to disturbances of carnitine homeostasis but the results of L-carnitine supplementation in HD patients have been conflicting. In the present prospective study, we investigated the effectiveness of intravenous L-carnitine in mitigating dialysis-related protein-energy wasting (PEW) based on pre-treatment albumin levels. Methods: Fifty patients (46% male, mean age 63±18.28 years, HD vintage 37.5 (7-288) months) received 1 g L-carnitine intravenously at the end of every HD session for 12 months. Clinical data were obtained from the medical records and charts. Intradialytic hypotension periods (defined as a decrease of systolic blood pressure by ≥ 20 mmHg) were recorded. Dietary habits were evaluated using a self-administered questionnaire prior to L-carnitine supplementation. Laboratory parameters were measured prior to the supplementation and controlled in 6-months intervals. Anthropometric measurements were performed prior to HD session, including „dry“ body weight and height, body mass index (BMI), and body composition analysis using bioimpedance spectroscopy. Malnutrition-inflammation score (MIS) was used as a scoring system representing the severity of PEW and an indicator of general functional capacity. Results: A significant increase in total cholesterol, predominantly on the account of LDL was found (p=0.005). Simultaneously, HDL decreased (p=0.001) while triglyceride levels remained unchanged. Although the rise in serum prealbumin could be observed, lean tissue index (LTI) decreased and fat tissue index (FTI) increased which resulted in reduction of the LTI/FTI ratio (p=0.002). When divided into two groups according to the pre-treatment albumin values (< 35 g/L or ≥35 g/L), patients from the higher albumin group showed significant increase in prealbumin (p=0.005), and improved MIS (p=0.03). Multivariate regression analysis showed that higher FTI after introduction of L-carnitine led to greater hemodynamic stability (OR 1.709, 95% CI 1.006-2.905, p=0.048). As there was no differences in HD treatment characteristics, primery kidney disease or residual diuresis we could conclude that positive energy balance (with an increase in prealbumin and FTI) eventually led to better hemodynamic stability. Conclusion: Our results show significant effects of L-carnitine supplementation on lipid metabolism. Further clinical trials, as well as experimental research are needed to define the role of lipid metabolism in CKD population. Significant benefits of L-carnitine supplementation in patients with better initial serum albumin levels suggest that this therapy should not be restricted to patients with the worst nutritional and overall status.

The Alteration of Carnitine Metabolism in Second Trimester in GDM and a Nomogram for Predicting Macrosomia

“…The study indicated a significant effect of C0 supplement (1500 mg/d) on lowering serum levels of TG, TC, and LDL in atherosclerosis patients [ 32 ]. Our study reported that serum C0 concentration was negatively correlated with FBG, LDL, TG, TC, and HCY and positively correlated with HDL especially in the GDM group, which is consistent with previous researches [ 33 ]. In Nowak et al's study, C0 showed no association with insulin resistance during OGTT, and C10 and C12 decreased during OGTT with worse insulin resistance as well [ 34 ].…”

Significance of Levocarnitine Treatment in Dialysis Patients

“…Levocarnitine has also been shown to impact insulin sensitivity and protein catabolism; it has been proposed that increased levocarnitine is likely to improve nutritional status by reducing insulin resistance [160]. In one study, when patients were divided into two groups according to albumin level (<3.5 g/dL or ≥3.5 g/dL) before levocarnitine treatment, the higher albumin group displayed a significant increase in the prealbumin level and an improved malnutrition-inflammation score (MIS) [161]. Some clinical trials have indicated that levocarnitine supplementation can improve nutritional status in hemodialysis patients.…”

“…Several studies have examined the effects of levocarnitine treatment on plasma lipid levels and inflammation-related parameters in patients on maintenance dialysis. These studies are listed inTable 4 [48,80,85,86,88,90,92,[131][132][133]161,[163][164][165][166][167][168][169][170][171][172][173].…”

Hemodialysis crossover study using a relative blood volume change-guided ultrafiltration control compared with standard hemodialysis: the BV-UFC study

“…During HD, BP was measured using an electronic sphygmomanometer at several timepoints, as follows: HD initiation, initiation of BV monitoring (10 min after HD initiation; BP baseline), and hourly during HD. IDH was defined as a reduction in systolic BP ≥20 mmHg from the baseline value [17][18][19]. The interventions for symptomatic IDH, which is accompanied with nausea, dizziness, and cramps, included prompt change of the dialysis bed (Trendelenburg position), oxygen inhalation, and infusion of saline.…”