Background/Aim:L-Carnitine is important in β-oxidation of fatty acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and especially by its loss during dialysis. The aim of our study was to test the influence of carnitine supplementation on plasma lipids, red blood cell count, and metabolism of free radicals. Methods: Twelve regularly dialyzed patients (average age 55.5 years, average dialysis treatment period 22.5 months) were given 15 mg/kg L-carnitine intravenously three times weekly (after each hemodialysis session) for 6 months. Laboratory markers of oxidative stress, lipid metabolism, and red blood cell count were measured before the supplementation and then controlled during two 3-month intervals. Nine patients were retested 3 months after the supplementation had ended. Results: All supplemented patients showed increased plasma free carnitine in comparison with the pretreatment values (113.3 ± 11.2 vs. 62.3 ± 16.7 µmol/l, p < 0.001). The proportion of decreased L-carnitine values after hemodialysis was reduced from 79 to 22%. Plasma total cholesterol (4.66 ± 0.30 mmol/l after treatment vs. 5.65 ± 1.53 mmol/l before treatment, p < 0.05) and LDL cholesterol (1.74 ± 0.86 vs. 2.81 ± 1.43 mmol/l, p < 0.05) decreased. The albumin concentration significantly increased from 34.8 ± 7.3 to 46.0 ±5.4 g/l (p < 0.05). Intraerythrocyte reduced glutathione increased from 1.65 ± 0.25 to 2.23 ± 0.16 mmol/l (p < 0.001), and the plasma antioxidant capacity increased from 1.65 ± 0.09 to 2.06 ± 0.17 mmol/l (p < 0.001). At the same time, plasma malondialdehyde decreased from 4.18 ± 0.72 to 3.07 ± 0.35 µmol/l (p < 0.001). The erythropoietin dose could be reduced from an average value of 5,500 to 3,500 U/week. No significant changes in the above-mentioned parameters were observed in a control group of dialyzed patients without L-carnitine supplementation. Conclusion: Regular carnitine supplementation of hemodialysis patients can improve their lipid metabolism, protein nutrition, red blood cell count, and antioxidant status.

Keywords:
Antioxidative defense, Atherogenesis, Carnitine, Erythropoietin, Free radicals, Hemodialysis, Inorganic phosphate, Lipids
1.
Bennett MJ, Hale DE, Pollitt RJ, Stanley CA, Variend S: Endocardial fibroelastosis and primary carnitine deficiency due to a defect in the plasma membrane carnitine transporter. Clin Cardiol 1996;19:243–246.
2.
Suzuki Y, Nariata M, Yamazaki N: Effects of L-carnitine on arrhythmias during hemodialysis. Jpn Heart J 1981;23:349–359.
3.
Battistella PA, Angelini C, Vergani L, Bertoli M, Lorenzi S: Carnitine deficiency induced during hemodialysis. Lancet 1978;i:939.
4.
Bohmer T, Bergren H, Eiklid K: Carnitine deficiency induced during intermittent haemodialysis for renal failure. Lancet 1978;i:126–128.
5.
Feinfeld DA, Kurian P, Chang JT, Dilimetin G, Arriola MR, Ward L, Manis T, Carvounis CP: Effect of oral L-carnitine on serum myoglobin in hemodialysis patients. Ren Fail 1996;18:91–96.
6.
Ahmad S, Robertson HT, Golper TA, Wolfson M, Kurtin P, Katz LA, Hirschberg R, Nicora R, Ashbrook DW, Kopple JD: Multicenter trial of L-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects. Kidney Int 1990;38:912–918.
7.
Bérard E, Barrillon D, Iordache A, Bayle J, Cassuto-Viguier E: Low dose of L-carnitine impairs membrane fragility of erythrocytes in hemodialysis patients. Nephron 1994;68:145–150.
8.
Bérard E, Iordache A: Effect of low doses of L-carnitine on the response to recombinant human erythropoietin in hemodialyzed children: About two cases. Nephron 1992;62:368–369.
9.
Boran M, Dalva I, Gonenc F, Cetin S: Response to recombinant human erythropoietin rHuEPO) and L-carnitine combination in patients with anemia of end-stage renal disease. Nephron 1996;73:314–315.
10.
De Felice SL, Lyons P, Cuffer MC, Sheridan MS: US–Italy L-carnitine hemodialysis utilization survey. Dial Transplant 1994;23:368–372.
11.
Labonia WD: L-Carnitine effects on anemia in hemodialyzed patients treated with erythropoietin. Am J Kidney Dis 1995;26:757–764.
12.
Pepine CJ: The therapeutic potential of carnitine in cardiovascular disorders. Clin Ther 1991;13:2–20.
13.
Arduini A, Rossi M, Mancinelli G, Belfiglio M, Scurti R, Radatti G, Shohet SB: Effect of L-carnitine and acetyl-L-carnitine on the human erythrocyte membrane stability and deformability. Life Sci 1990;47:2395–2400.
14.
Matsumura M, Hatakeyama S, Koni I, Mabuchi H, Muramoto H: Correlation between serum carnitine levels and erythrocyte osmotic fragility in hemodialysis patients. Nephron 1996;72:574–578.
15.
Cristol JP, Canaud B, Rabesandratana H, Gaillard I, Serre A, Mion C: Enhancement of reactive oxygen species production and cell surface markers expression due to hemodialysis. Nephrol Dial Transplant 1994;9:389–394.
16.
Kuwahara T, Markert M, Wauters JP: Neutrophil oxygen radical production by dialysis membranes. Nephrol Dial Transplant 1988;3:661–665.
17.
Kooistra MP, Struyvenberg A, van Es A: The response to recombinant human erythropoietin in patients with the anemia of end-stage renal disease is correlated with serum carnitine levels. Nephron 1991;57:127–128.
18.
Yllmaz Selcuk N, San A, Tonbul HZ, Aksoy H, Ika I, Bakan E: Effects of nutritional status and oral essential amino acid replacement on serum L-carnitine levels of chronically hemodialyzed patients. Nephron 1996;72:341–342.
19.
Consensus Group Statement: Role of L-carnitine in treating renal dialysis patients. Dial Transplant 1994;23:177–181.
20.
Vacha GM, Giorcelli G, Siliprandi A, Corsi M: Favorable effects of L-carnitine treatment on hypertriglyceridemia in hemodialysis patients: Decisive role of low levels of high-density lipoprotein-cholesterol. Am J Clin Nutr 1983;38:532–540.
21.
Racek J, Eiselt J, Holeček V, Krejčová I: Extra- and intracellular antioxidative defense in patients under regular dialysis treatment. Proc XVIth. Int Congr of Clinical Chemistry, London 1996, pp 276–278.
© 2001 S. Karger AG, Basel
2001
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