scholarly journals Significance of Levocarnitine Treatment in Dialysis Patients

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1219
Author(s):  
Hiroyuki Takashima ◽  
Takashi Maruyama ◽  
Masanori Abe
Keyword(s):  
Dietary Intake ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Amino Acid Derivative ◽  
Long Chain Fatty Acids ◽  
Dialysis Patients ◽  
Naturally Occurring ◽  
Clinical Disorders ◽  
Liver And Kidney ◽  
Endogenous Synthesis

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.

scholarly journals Effects of l-Carnitine Supplementation in Patients Receiving Hemodialysis or Peritoneal Dialysis

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3371 ◽  
Author(s):  
Masako Kuwasawa-Iwasaki ◽  
Hiroaki Io ◽  
Masahiro Muto ◽  
Saki Ichikawa ◽  
Keiichi Wakabayashi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Function ◽  
Acid Metabolism ◽  
Carnitine Deficiency ◽  
Muscle Spasm ◽  
Free Carnitine ◽  
Carnitine Supplementation ◽  
Dialysis Patients ◽  
Muscle Spasms ◽  
Total Carnitine

l-carnitine is an important factor in fatty acid metabolism, and carnitine deficiency is common in dialysis patients. This study evaluated whether l-carnitine supplementation improved muscle spasm, cardiac function, and renal anemia in dialysis patients. Eighty Japanese outpatients (62 hemodialysis (HD) patients and 18 peritoneal dialysis (PD) patients) received oral l-carnitine (600 mg/day) for 12 months; the HD patients further received intravenous l-carnitine injections (1000 mg three times/week) for 12 months, amounting to 24 months of treatment. Muscle spasm incidence was assessed using a questionnaire, and cardiac function was assessed using echocardiography. Baseline free carnitine concentrations were relatively low in patients who underwent dialysis for >4 years. Total carnitine serum concentration, free carnitine, and acylcarnitine significantly increased after oral l-carnitine treatment for 12 months, and after intravenous l-carnitine injection. There was no significant improvement in muscle spasms, although decreased muscle cramping after l-carnitine treatment was reported by 31% of patients who had undergone HD for >4 years. Hemoglobin concentrations increased significantly at 12 and 24 months in the HD group. Therefore, l-carnitine may be effective for reducing muscle cramping and improving hemoglobin levels in dialysis patients, especially those who have been undergoing dialysis for >4 years.

Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 235-238
Author(s):  
S. Ramalakshmi ◽  
Bjoe Baben ◽  
Ben S. Ashok ◽  
V. Jayanthi ◽  
Nancy Leslie ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Dialysis Patients ◽  
Carnitine Level ◽  
Daily Urine ◽  
The Mean ◽  
Daily Urine Output

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.

scholarly journals Carnitine Concentrations in Dialysed and Undialysed Patients with Chronic Renal Insufficiency

1986 ◽  
Vol 23 (6) ◽  
pp. 671-675 ◽  
Author(s):  
S Rodriguez-Segade ◽  
C Alonso De La Peña ◽  
M Paz ◽  
D Novoa ◽  
R Romero ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Control Group ◽  
Serum Concentrations ◽  
Total Carnitine ◽  
Haemodialysis Treatment ◽  
Endogenous Synthesis

Free carnitine, acylcarnitine and total carnitine serum concentrations have been measured in chronic renal insufficiency patients under conservative treatment, in patients under regular haemodialysis treatment and in healthy controls. In the undialysed patients the levels of free carnitine, acylcarnitine and total carnitine were all clearly higher than those of the control group. The free carnitine and total carnitine levels of undialysed subjects were also higher than in regularly haemodialysed patients, showing that dialysis produces plasma carnitine losses that are not compensated for by endogenous synthesis of carnitine (this finding supports published reports of tissue carnitine deficiency in patients undergoing regular haemodialysis). The acylcarnitine levels of dialysed and undialysed patients were not significantly different, however; both were very much higher than that of control group. The hypercarnitinaemia of the patients under conservative treatment suggests that the impairment of renal function causes a reduction in the elimination of carnitine via the kidney.

Carnitine Deficiency in Epilepsy: Risk Factors and Treatment

1995 ◽  
Vol 10 (2_suppl) ◽  
pp. 2S32-2S39 ◽  
Author(s):  
David L. Coulter
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Preliminary Data ◽  
Metabolic Diseases ◽  
Drug Effects ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Specific Drug ◽  
Asymptomatic Patients ◽  
The Relationship

Numerous studies have shown that plasma carnitine levels are significantly lower in patients taking valproate than in controls. Free carnitine deficiency is not uncommon in these patients and also occurs in newborns with seizures and in patients taking other anticonvulsant drugs. Carnitine deficiency in epilepsy results from a variety of etiologic factors including underlying metabolic diseases, nutritional inadequacy, and specific drug effects. The relationship between carnitine deficiency and valproate-induced hepatotoxicity is unclear. Carnitine treatment does not always prevent the emergence of serious hepatotoxicity, but it does alleviate valproate-induced hyperammonemia. These studies suggest that specific risk factors for carnitine deficiency can be identified. Preliminary data suggest that carnitine treatment may benefit high-risk, symptomatic patients and those with free carnitine deficiency. Carnitine treatment is not likely to benefit low-risk, asymptomatic patients and those with normal carnitine levels. (J Child Neurol 1995;10(Suppl):2S32-2S39).

scholarly journals Bioactive Compounds from Brassicaceae: a Beneficial Contribution in our Everyday Diet

2011 ◽  
Vol 68 (2) ◽  
Author(s):  
Renato IORI ◽  
Gina R. DE NICOLA ◽  
Manuela BAGATTA ◽  
Eleonora PAGNOTTA
Keyword(s):  
Secondary Metabolites ◽  
Dietary Intake ◽  
Bioactive Compounds ◽  
Chemical Structure ◽  
Side Chain ◽  
Variable Part ◽  
Naturally Occurring ◽  
Interesting Class

Dietary intake of Brassicaceae (Crucifers) provides not only nutrients, but also a highly interesting class of secondary metabolites beneficial to health, known as glucosinolates (GLs). These compounds possess a -D-glucopyranosyl unit connected to a O-sulfated anomeric Z-thiohydroximate function, and a side chain R which is the only variable part of the chemical structure. Up to now, more than 120 naturally-occurring GLs have been carachterized

scholarly journals Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden

2008 ◽  
Vol 87 (4) ◽  
pp. 993-1001 ◽  
Author(s):  
Sofia Klingberg ◽  
Lars Ellegård ◽  
Ingegerd Johansson ◽  
Göran Hallmans ◽  
Lars Weinehall ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Serum Cholesterol ◽  
Plant Sterols ◽  
Inverse Relation ◽  
Northern Sweden ◽  
Naturally Occurring

Carnitine insufficiency in children with inborn errors of metabolism: prevalence and treatment efficacy

2015 ◽  
Vol 28 (11-12) ◽  
Author(s):  
Ilgar Mamedov ◽  
Irina Zolkina ◽  
Ekaterina Nikolaeva ◽  
Pavel Glagovsky ◽  
Vladimir Sukhorukov
Keyword(s):  
Fatty Acids ◽  
Plasma Level ◽  
Psychomotor Retardation ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Hereditary Diseases ◽  
Inborn Errors ◽  
Carnitine Level ◽  
Subsequent Investigation ◽  
Systemic Carnitine Deficiency

AbstractCarnitine is necessary for the transfer of long-chain fatty acids from the cytosol into mitochondria for subsequent β-oxidation. A carnitine deficiency results in impaired energy production from fatty acids.We reviewed the plasma level of total carnitine, free carnitine, and acylcarnitines in 1270 children with psychomotor retardation, low growth, and weight parameters. Tandem mass spectrometry (MS/MS) was applied. Low free carnitine level in plasma was used as a marker of carnitine deficiency.A total of 102 (8%) children had free carnitine level <19 μmol/L (norm 19–60 μmol/L). As a result of the subsequent investigation, hereditary diseases were diagnosed in 76 (¾) children and out of that 19 had very low free carnitine plasma level (<10 μmol/L). Fanconi syndrome, fat oxidation defects, primary systemic carnitine deficiency, mitochondrial encephalomyopathy, and Noonan syndrome were revealed in these 19 children.Efficacy of levocarnitine treatment in children with very low free carnitine level differs according to pathogenesis of diseases. The highest efficacy was observed in primary systemic carnitine deficiency.

scholarly journals Complementary Biomarker Assessment of Components Absorbed from Diet and Creatinine Excretion Rate Reflecting Muscle Mass in Dialysis Patients

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1827 ◽  
Author(s):  
Adrian Post ◽  
Akin Ozyilmaz ◽  
Ralf Westerhuis ◽  
Karin Ipema ◽  
Stephan Bakker ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Muscle Mass ◽  
Protein Intake ◽  
Excretion Rate ◽  
Protein Energy Malnutrition ◽  
Dialysis Patients ◽  
Sodium Potassium ◽  
Waste Products ◽  
Creatinine Excretion ◽  
Creatinine Excretion Rate

To prevent protein energy malnutrition (PEM) and accumulation of waste products, dialysis patients require diet adjustments. Dietary intake assessed by self-reported intakes often provides biased information and standard 24-h urinary excretion is inapplicable in dialysis patients. We aimed to assess dietary intake via a complementary, less biased biomarker method, and to compare this to dietary diaries. Additionally, we investigated the prospective association of creatinine excretion rate (CER) reflecting muscle mass with mortality. Complete intradialytic dialysate and interdialytic urinary collections were used to calculate 24-h excretion of protein, sodium, potassium, phosphate and creatinine in 42 chronic dialysis patients and compared with protein, sodium, potassium, and phosphate intake assessed by 5-day dietary diaries. Cox regression analyses were employed to investigate associations of CER with mortality. Mean age was 64 ± 13 years and 52% were male. Complementary biomarker assessed (CBA) and dietary assessed (DA) protein intake were significantly correlated (r = 0.610; p < 0.001), but there was a constant bias, as dietary diaries overestimated protein intake in most patients. Correlations were found between CBA and DA sodium intake (r = 0.297; p = 0.056), potassium intake (r = 0.312; p = 0.047) and phosphate uptake/intake (r = 0.409; p = 0.008). However, Bland-Altman analysis showed significant proportional bias. During a median follow-up of 26.6 (25.3–31.5) months, nine dialysis patients (23%) died. CER was independently and inversely associated with survival (HR: 0.59 (0.42–0.84); p = 0.003). Excretion measurements may be a more reliable assessment of dietary intake in dialysis patients, as this method is relatively free from biases known to exist for self-reported intakes. CER seems to be a promising tool for monitoring PEM.

Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Hemodialysis

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 38-44 ◽  
Author(s):  
Yoshinari Hatanaka ◽  
Terumi Higuchi ◽  
Yurie Akiya ◽  
Tomomi Horikami ◽  
Ritsukou Tei ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Multivariate Regression ◽  
Reduction Rate ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Prevalence Rates ◽  
Carnitine Level ◽  
Serum Free ◽  
Free Serum

Background: Patients on hemodialysis (HD) are known to be at risk of carnitine deficiency. The aims of this study were to investigate the prevalence of carnitine deficiency in patients on dialysis and to compare the likelihood of a reduction in the serum carnitine level on HD with that on hemodiafiltration (HDF). Methods: The prevalence of carnitine deficiency, defined as a serum free carnitine level < 20 μmol/L, and that of carnitine insufficiency, defined as an acyl/free carnitine ratio > 0.4, was investigated in 150 patients on dialysis. The reduction rate of serum carnitine was then compared between HD and HDF. Results: The prevalence of carnitine deficiency and that of carnitine insufficiency was 25.3 and 86.7%, respectively. Patients at high risk of carnitine deficiency accounted for 64.7%. Multivariate regression identified an association of duration of dialysis with the free serum carnitine level. The reduction rates of serum free carnitine in HD and HDF were 64 ± 4 and 75 ± 7%, respectively (p < 0.0001). Conclusion: The prevalence rates of carnitine deficiency and carnitine insufficiency were high in patients on dialysis. The serum carnitine reduction rate was greater with HDF than with HD.

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