Effects of L-Carnitine on Mineral Metabolism in the Multicentre, Randomized, Double Blind, Placebo-Controlled CARNIDIAL Trial

Abstract

Background: The use of L-carnitine has been proposed in haemodialysis (HD) when deficiency is present to improve anaemia resistant to erythropoietin stimulating agent, intradialytic hypotension or cardiac failure. We tested the effects of L-carnitine supplementation on parameters of chronic kidney disease-mineral bone disorder. Methods: CARNIDIAL was a randomized, double-blinded trial having included 92 incident HD subjects for a 1-year period to receive L-carnitine versus placebo. Determinant factors of C-terminal fibroblast growth factor 23 (cFGF23) and intact FGF23 were studied including Klotho level. The L-carnitine effect on mineral metabolism was analyzed between groups by mixed linear models for repeated measurements. Results: Klotho was below the lower limit of quantification (LLOQ) in 55% of the 163 samples. In multivariate analysis, cFGF23 was positively correlated with calcium and phosphate and was higher in subjects having Klotho > LLOQ. No correlation existed between Klotho and phosphate and phosphate was even higher in subjects having Klotho > LLOQ (p < 0.001). Both forms of FGF23 were not related to iron markers nor to IV iron dose. No L-carnitine effect was detected on parathyroid hormone (PTH) or FGF23 during the study period where PTH slightly decreased over time, whereas FGF23 increased. But calcium and phosphate increased more in the L-carnitine group. Conclusion: L-carnitine supplementation increased calcium and phosphate plasma concentrations with no detected downregulation effect on PTH and FGF23. (Clinical Trial 00322322, May 5, 2006).

Evaluation of L-carnitine in the treatment of experimentally induced hypomagnesemia in sheep

“…There was significant decrease in serum urea with L-carnitine injectiont 24 hour after treatment. Similar finding was recorded by Mercadal et al (2018). There was significant decrease in serum K in case of Lcarnitine treatment.…”

“…Treatment of hypomagnesemic rams with traditional treatment and L-carnitine resulted in significant elevation of serum Mg, Ca and PTH in experimentally induced hypomagnesemic rams than traditional treatment only. Haarenen 2003and Mercadal et al(2018) recorded that L-carnitine supplementation increased serum calcium concentration. The traditional treatment with L-carnitine resulted in significant elevation of serum glucose in hypomagnesemic rams than traditional treatment only which is coincided with the results of Kaçar et al, (2010) and Chapa et al, (2001).…”

“…L-carnitine has a number of functions, such as transforming fatty acids into energy, preventing ketosis, carrying ATP from mitochondria to cytosole, (Haemeyer et al, 1997;Harmeyer 2001) L-carnitine supplementation has beneficial effects on animal performance by enhancing resistance to metabolic diseases, preventing some diseases, strengthening immune system, and playing an important role in metabolic and physiological processes (Fathi and Farahzadi 2014). L-carnitine supplementation increased serum Ca concentrations in patients with renal diseases (Mercadal et al, 2018). Moreover, administration of L-carnitine in resulted in elevation of plasma glucose concentration and reduction of blood urea concentration (Chapa et al, 2001, Mercadal et al, 2018.…”

“…L-carnitine supplementation increased serum Ca concentrations in patients with renal diseases (Mercadal et al, 2018). Moreover, administration of L-carnitine in resulted in elevation of plasma glucose concentration and reduction of blood urea concentration (Chapa et al, 2001, Mercadal et al, 2018. Parenteral administration of L-carnitine was used a protective measure against pregnancy toxemia via increasing serum glucose concentration in goats (Kaçar et al, 2010).…”

Significance of Levocarnitine Treatment in Dialysis Patients

“…However, the CARNIDIAL trial found no improvement in the ERI with levocarnitine administration in patients with a shorter duration of hemodialysis (<6 months) and no documented carnitine deficiency. In addition, levocarnitine treatment increased calcium and phosphate levels and was not associated with parathyroid hormone or fibroblast growth factor 23 [94,95].…”