Association between resistance to erythropoiesis‐stimulating agents and carnitine profile in patients on maintenance haemodialysis

Kamei, Daigo; Tsuchiya, Ken; Nitta, Kosaku; Mineshima, Michio; Akiba, Takashi

doi:10.1111/nep.13079

Cited by 12 publications

(25 citation statements)

References 23 publications

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“…The resistance of erythropoietin stimulating agents to anemia in patients undergoing dialysis was evaluated as erythropoietin resistance index (32,33). The erythropoietin resistance index was defined as the average weekly dose of recombinant human erythropoietin (IU)/body weight (kg)/hemoglobin (g/dL) (32,33). The ratio of recombinant human erythropoietin darbepoetin alfa or epoetin beta pegol was converted to 200:1 (34).…”

Section: Definition Of Erythropoietin Resistance Indexmentioning

confidence: 99%

Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

et al. 2020

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Background: Zinc deficiency is common and is associated with erythropoietin resistant anemia, dysgeusia, and hypogonadism in patients undergoing hemodialysis. However, the prevalence and clinical effects of zinc deficiency in patients undergoing peritoneal dialysis (PD) have not been determined. Methods: This was a retrospective, cross-sectional study. The prevalence of serum zinc deficiency and the clinical factors related to serum zinc concentration were determined in 49 patients undergoing PD [mean age 59.5 years (±14.8 years), 38/49 were men (78.6%), median PD period 24.0 months (12.5-45.0 months)]. A serum zinc concentration <60 µg/dL was defined as serum zinc deficiency, and a serum zinc concentration between 60 and 80 µg/dL as possible serum zinc deficiency. Results: Serum zinc deficiency was present in 51% (25/49) of the patients, and possible serum zinc deficiency was present in 45% (22/49) of patients undergoing PD. Multivariate analysis showed that serum zinc concentration significantly correlated with serum ferritin concentration (β = 0.357, P < 0.01). Conclusions: The prevalences of serum zinc deficiency and possible serum deficiency are high and serum zinc concentration correlates with serum ferritin concentration in patients undergoing PD.

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Section: Definition Of Erythropoietin Resistance Indexmentioning

confidence: 99%

Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

et al. 2020

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“…It can also be obtained from the diet [17]. Carnitine is an essential aminoacid derivative having vital roles in fatty-acid metabolism in cardiac muscle and skeletal muscle [18]. Carnitine is present in two forms in the body, acylcarnitine, and free carnitine, and the sum of them is defined as total carnitine [19].…”

Section: Introductionmentioning

confidence: 99%

“…It has a significant function in organizing energetic substrates flow and their balance through the cell wall. The nutritional status of HD patients is positively affected by carnitine by enhancing a positive protein balance, and by reducing insulin resistance and chronic inflammation [18]. Carnitine is vital for RBCs to perform their metabolic function in renal anemia [19] that can have a negative impact on erythrocyte production and survival [20].…”

Section: Introductionmentioning

confidence: 99%

Hepcidin and its Related Hematological Biomarkers of Anemia in Children on Hemodialysis: Role of Carnitine Deficiency

El-Toukhy

Fadel

Elshamaa

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Anemia is one of the most common complications in end-stage renal disease (ESRD) patients. Hepcidin is a hormone that regulates iron homeostasis in patients with ESRD. Carnitine deficiency is commonly seen in hemodialysis (HD) patients. AIM: This study aimed to investigate the relationship between hepcidin and inflammatory and other anemia markers in children with ESRD and to evaluate the association of carnitine deficiency with anemia in these patients. SUBJECTS AND METHODS: Thirty pediatric patients with ESRD undergoing HD, and thirty healthy, age- and sex-matched children served as controls were included in the study. Serum levels hepcidin, iron status, high-sensitivity C-reactive protein, and total carnitine were measured. RESULTS: Statistically significant increases in serum levels of hepcidin (100.7 ± 0.99 ng\ml vs. 77.43 ± 0.8 ng\ml, p = 0.000), was found in HD children as compared to healthy controls. Statistically significant increase in serum levels of hs-CRP (3.94 ± 0.19 mg/l vs. 1.36 ± 0.07 mg/l, p = 0.04) was found in HD children as compared to healthy controls. However, serum levels of carnitine (29.59 ± 2.46 μmol/L vs. 36 ± 2.39 μmol/L, p = 0.000) showed statistically significant decreases in HD children as compared to healthy controls positive correlation was found between hepcidin and hs-CRP (r = 0.059, p = 0.042). Furthermore, a positive correlation was present between serum carnitine levels and serum iron levels (r = 0.651, p = 0.042). CONCLUSION: Serum hepcidin may be a more useful biomarker of functional iron deficiency in children on HD. The efficacy of carnitine treatment for children on HD with carnitine deficiency and its effect on anemia needs to be studied.

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“…In recent years, some correlations have been reported between acylcarnitine and chronic kidney disease (CKD) exacerbation [ 4 ], anemia [ 5 , 6 ], and reduced physical function [ 7 ]. Carnitine deficiency in hemodialysis patients can impair the efficiency of adenosine triphosphate (ATP) synthesis from long-chain fatty acids in the mitochondria.…”

Section: Introductionmentioning

confidence: 99%

Association between 4-year all-cause mortality and carnitine profile in maintenance hemodialysis patients

Kamei

Tsuchiya

et al. 2018

PLoS ONE

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BackgroundPatients on dialysis are in a chronic carnitine-deficient state. This condition may be associated with abnormalities of the fatty acid and organic acid metabolisms. Carnitine is required for β-oxidation of the long-chain fatty acids; therefore, carnitine deficiency decreases the efficiency of ATP synthesis and may incur death. However, the details of this association remain unknown. We examined the relationship between β-oxidation efficiency represented by the carnitine profile and 4-year all-cause mortality in hemodialysis patients.MethodsThe carnitine profiles of 122 hemodialysis patients were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The associations between the 4-year all-cause mortality and carnitine profile as well as the clinical backgrounds of the patients were investigated. A survival analysis was conducted by the Kaplan–Meier survival method and multivariable Cox proportional hazard analysis. The bootstrap method was performed to confirm the stability and robustness of our model.ResultsOf the 122 subjects analyzed, 111 were selected and 24 died during the observation period. Stepwise multivariable Cox regression demonstrated that diabetes state [Hazard ratio (95% confidence interval), 4.981 (2.107–11.77)], age [HR (95% CI), 1.052 (1.014–1.091)], and the acetylcarnitine/(palmitoylcarnitine+octadecenoylcarnitine) [C2/(C16+C18:1)] ratio [HR (95% CI), 0.937 (0.904–0.971)] were independent significant factors of 4-year all-cause mortality. The bootstrap method confirmed the significance of these three factors.ConclusionThe 4-year all-cause mortality negatively correlated with the C2/(C16+C18:1) ratio. Improvement of the impaired β-oxidation state after L-carnitine administration may ameliorate prognosis.

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Association between resistance to erythropoiesis‐stimulating agents and carnitine profile in patients on maintenance haemodialysis

Abstract: ERI positively correlated with long-chain C18 acylcarnitine and negatively correlated with short-chain C5-OH acylcarnitine. C5-OH and C18 acylcarnitines at baseline might be contributing factors in distinguishing responders from nonresponders after L-carnitine administration.

Cited by 12 publications

References 23 publications

Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

Serum Zinc Concentration Correlates With Ferritin Concentration in Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

Hepcidin and its Related Hematological Biomarkers of Anemia in Children on Hemodialysis: Role of Carnitine Deficiency

Association between 4-year all-cause mortality and carnitine profile in maintenance hemodialysis patients

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