Carnitine Metabolism in Chronic Renal Failure

Guarnieri, Gianfranco; Toigo, G.; Crapesi, L.; Situlin, R.; Bianco, M. A. Del; Corsi, Marco; LoGreco, Paolo; Paviotti, Giulia; Mioni, G.; Campanacci, L

doi:10.1159/000415742

Cited by 32 publications

(30 citation statements)

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“…However, inconsistent results on serum triglycerides and on the other lipid parameters have been repeatedly reported in the literature. Some authors have noticed some 'responders' whose triglycerides decreased after carnitine administration and some 'nonresponders' [14,19,32,33]. In fact, in our study a profound decrease in serum triglycerides was evident in 12 patients.…”

Section: Discussionsupporting

confidence: 48%

“…In fact, it has been reported that in patients receiving too high a carnitine supplementation even an increase in serum triglycerides may be found [14,15,27,35], due to carnitine-dependent shuttling of acetyl groups to the cytosol, where they can be used for fatty acid resynthesis and in liver for the subsequent triglyceride and VLDL synthesis [33]. Even though the ideal lipid-lowering dose or route of administration of carnitine is not known, the hypotriglyceridemic effect observed in our study could be related to the relatively optimal dose given.…”

Section: Discussionmentioning

confidence: 99%

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Effect of <i>L</i>-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients

Elisaf

Bairaktari²,

Katopodis³

et al. 1998

Am J Nephrol

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It has been reported that cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response. We undertook the present study to determine if there is any hypolipidemic effect of L-carnitine on Greek dialysis patients in concert with the dialysate buffer composition (acetate or bicarbonate). A total of 28 patients (16 male, 12 female), mean age 43 years (range 21–61), with end-stage renal disease on maintenance hemodialysis for a mean period of 25 months (range 7–84) were studied. The dialysis schedule was 4 h, 3 times/week using cuprophane hollow-fiber dialyzers and acetate (n = 14) or bicarbonate (n = 14) dialysate. In all patients L-carnitine (5 mg/kg body weight) was infused intravenously 3 times/week at the end of each hemodialysis session. Blood samples for carnitine and lipid determinations were obtained before treatment, and 3 and 6 months following treatment. Even though L-carnitine did not modify most of the serum lipid levels, a significant decrease in serum triglycerides was evident in the whole group of patients (from 225 ± 76 to 201 ± 75 mg/dl, p = 0.03). Furthermore, L-carnitine could decrease serum triglycerides only in hypertriglyceridemic patients (from 260 ± 64 to 226 ± 82 mg/dl, p < 0.05). L-Carnitine resulted in a reduction of serum triglycerides in both patients on bicarbonate and on acetate dialysis, while there were no significant differences in the changes of lipid parameters after L-carnitine between the two groups of hemodialysis patients. We conclude that relatively low doses of L-carnitine supplementation could contribute to the management of some hypertriglyceridemic hemodialysis patients.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Effect of <i>L</i>-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients

Elisaf

Bairaktari²,

Katopodis³

et al. 1998

Am J Nephrol

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“…Under normal conditions these esters are further metabolized to regenerate free CoA. When adequate amounts of carni tine are in the matrix of mitochondria, a constant supply of CoA-SH can be provided by converting acyl-CoA Tabic I. Metabolic functions of carnitine [23,24,112,[125][126][127][128][129] Established Shuttle of long-chain fatty acids into the mitochondria for beta oxidation: stimulation of ketogenesis in the liver______________ Tenable Modulation ('buffering') of the bound C'oA to free CoA (acyl-CoA/CoA-SH ratio), thereby regeneration of sequestrated CoA-SH to maintain normal metabolic processes 'Acyl detoxification': selective elimination of acyl residues (action of reversible'sink' for acyl residues) with excretion into the urine or elimination during dialysis Shuttle of chain-shortened products (acetyl and medium-chain acyl residues) out of peroxisomes into other biosynthetic pathways which require acetyl-CoA_________________________ Suggested Branched-ehain amino acid metabolism (faciiitative role in the regulation of protein degradation and in the oxidation of alpha-keto acids of valine, leucine, and isoleucine Storing and transport of metabolic energy Stimulation of gluconeogenesis Modified according to Guarnieri et al [27], derivatives and a reduction of the amounts of CoA-SH. The acyl groups, however, have a detergent-like function.…”

Section: Carnitine Function and Metabolismmentioning

confidence: 99%

Carnitine Abnormalities in Patients with Renal Insufficiency

Wanner

Hörl²

1988

Nephron

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“…In 1974, Bohmer et al [4] were the first to report the development of carnitine deficiency in patients receiving hemodialysis. Since that report, carnitine deficiency has been variably associated with the hemodialysis 'postdia lysis syndrome', characterized by muscle weakness and cramps [3][4][5]13]. It has also been suggested that carni tine deficiency may contribute to the development of hypertriglyceridemia and the cardiomyopathy fre quently associated with chronic dialysis [3.6, 10, 13, 25.…”

Section: Discussionmentioning

confidence: 99%

Carnitine Status of Pediatric Patients on Continuous Ambulatory Peritoneal Dialysis

et al. 1990

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Plasma carnitine and the effect of oral carnitine supplementation on serum triglycerides was studied in 12 pediatric patients receiving continuous ambulatory peritoneal dialysis (CAPD). Baseline evalution of all patients included plasma carnitine and serum triglyceride values. Following randomization into two groups, only group 2 patients received oral L-carnitine supplementation, 100 mg/kg/day, for 2 months. The initial laboratory evaluation was repeated at the conclusion of the study. Plasma carnitine values were also determined from a control population. Mean baseline plasma carnitine concentrations of group 1 (39.8 ± 8.0 nmol/ml) and group 2 (45.2 ± 10.3nmol/ml) patients were not significantly different from each other or from the control population. Serum triglyceride values were elevated in both groups (group 1 – 206.5 ± 100.0 mg/dl; group 2 – 279.3 ± 74.5 mg/dl). After 2 months, the mean plasma carnitine concentration of group 2 patients increased to 147.7 ± 84.1 nmol/ml, significantly greater than the value of group 1, 32.8 ± 8.0 nmol/ml (p < 0.004). However, no significant change in the serum triglyceride level was noted in either group. We conclude that the plasma carnitine status of pediatric patients receiving CAPD is normal and that oral carnitine supplementation does not lead to the resolution of hypertriglyceridemia.

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Carnitine Metabolism in Chronic Renal Failure

Cited by 32 publications

References 0 publications

Effect of <i>L</i>-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients

Effect of <i>L</i>-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients

Carnitine Abnormalities in Patients with Renal Insufficiency

Carnitine Status of Pediatric Patients on Continuous Ambulatory Peritoneal Dialysis

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