Effects of intravenous l-carnitine on myocardial fatty acid imaging in hemodialysis patients: responders or non-responders to l-carnitine

Abstract

We investigated whether chronic intravenous administration of l-carnitine could improve myocardial fatty acid imaging in patients on maintenance hemodialysis. We enrolled 72 hemodialysis patients who had impaired myocardial fatty acid imaging and left ventricular dysfunction not based on coronary lesion. l-Carnitine (1,000 mg) was intravenously administered after dialysis for 1 year to 36 participants (Carnitine group), while not in the other 36 participants (Control group). Single-photon emission computed tomography (SPECT) using an iodinated fatty acid analogue, BMIPP, was performed. Uptake on SPECT images was graded in 17 segments on a five-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores. During follow-up, 19 participants were discontinued from the study, and 53 participants (65 ± 12 years: 27 carnitine, 26 control) were analyzed. The mean BMIPP summed scores 1 year after carnitine administration did not differ from that before in the carnitine group, nor from that in the control group. However, improved SPECT (Changes in BMIPP summed scores <−20%) was found in 7 (25.9%) participants in the carnitine, whereas in 2 (7.7%) in the control group. Multivariate logistic analysis showed the improved SPECT was inversely associated with baseline serum albumin levels (1 g/L: odds ratio, 0.669); the cut-off was 35 g/L. Chronic intravenous l-carnitine might improve myocardial fatty acid imaging in a selected group of hemodialysis patients with hypoalbuminemia.

Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials

“…The quality assessment of the included RCTs is shown in Figure 1 . Four studies [ 12 , 13 , 21 , 26 ] did not report the method of randomization, whereas the others reported a randomization number sequence or adaptive minimization randomization scheme. There were three studies [ 13 , 17 , 26 ] using the blind method; blind methods of all the other studies are unclear.…”

“…There were three studies [ 13 , 17 , 26 ] using the blind method; blind methods of all the other studies are unclear. One study [ 21 ] had high performance bias for the reason that more than 20% of patients were lost to follow-up. Selective reporting was found in three studies [ 13 , 21 , 26 ] because they did not present the ITT analysis data.…”

“…One study [ 21 ] had high performance bias for the reason that more than 20% of patients were lost to follow-up. Selective reporting was found in three studies [ 13 , 21 , 26 ] because they did not present the ITT analysis data. These studies had high performance bias and detection bias.…”

“…Some reports [21, 24, 25] indicated that clinical symptom, cardiac function, and renal function in CHF patients with renal insufficiency were more likely to be ameliorated with L-C treatment.…”

L-carnitine Improved the Cardiac Function via the Effect on Myocardial Fatty Acid Metabolism in a Hemodialysis Patient

“…Sakurabayashi et al (18) reported that the oral administration of L-carnitine to HD patients did not affect the myocardial accumulation on BMIPP scintigraphy, although it increased the washout rate. Recently, Nishimura et al (19) reported that the BMIPP summed scores with SPECT after the intravenous administration of L-carnitine did not differ markedly from those before it, although they also suggested that the cardiac function was improved in the subgroup of patients with reduced BMIPP summed scores after the administration. Taken thogether, these findings failed to clarify the actual effect of L-carnitine administration on the myocardial fatty acid metabolism and the cardiac function, as reported previously (4, 5).…”