The unexpected effects of L-carnitine supplementation on lipid metabolism in hemodialysis patients

Scientific paper - Original scientific paper

• Author: Lea Katalinić
• Author: Branimir Krtalić
• Author: Bojan Jelaković
• Author: Nikolina Bašić-Jukić
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

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 proteinenergy
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 selfadministered
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.

• Keywords (english): Aged; Aged, 80 and over; Albumins/analysis; Body Composition/drug effects; Carnitine/administration & dosage; Carnitine/pharmacology; Female; Hemodynamics; Humans; Kidney Failure, Chronic/metabolism; Kidney Failure, Chronic/therapy; Lipid Metabolism/drug effects; Male; Middle Aged; Nutritional Status; Prospective Studies; Protein-Energy Malnutrition/etiology; Renal Dialysis/adverse effects
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Kidney and Blood Pressure Research
• Numbering: vol. 43, no. 4, pp. 1113-1120
• p-ISSN: 1423-0143
• DOI: https://doi.org/10.1159/000491807
• URN:NBN: urn:nbn:hr:105:255507
• Publication: 2018
• Document URL: https://doi.org/10.1159/000491807
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 10:05:43