Endogenous plasma carnitine pool composition and response to erythropoietin treatment in chronic haemodialysis patients

Reuter, Stephanie E; Faull, Randall J.; Ranieri, Enzo; Evans, Allan M.

doi:10.1093/ndt/gfn588

Cited by 37 publications

(37 citation statements)

References 40 publications

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“…There are some studies that found a significant negative correlation of plasma total carnitine levels and rHuEPO requirement in hemodialyzed patients [19,20]. In our study, there was no significant difference in the plasma carnitine levels before or after treatment between responders and nonresponders.…”

Section: Discussioncontrasting

confidence: 53%

Long-Term Effects of Oral <smlcap>L</smlcap>-Carnitine Supplementation on Anemia in Chronic Hemodialysis

Kudoh¹,

Aoyama²,

Torii³

et al. 2014

Cardiorenal Med

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Background: The therapeutic role of L-carnitine (LC) on the anemia of chronic hemodialized patients is still controversial. In order to clarify the long-term effects of LC administration on renal anemia, an open, observational 12-month study was performed. Methods: Twenty stable outpatients undergoing hemodialysis were administered LC 900 mg p.o. daily for 12 months. The recombinant human erythropoietin (rHuEPO) dose was adjusted monthly when necessary to maintain the target hemoglobin (Hb) levels. Results: The free LC level increased, while the acyl/free LC ratio decreased significantly 3 months after administration and was then maintained until the end of the study. There was no difference in Hb levels and the erythropoietin resistance index (ERI) during the study period. However, it was observed that ERI decreased significantly in 7 out of 18 patients (responders) 5 months after LC administration and was maintained thereafter (almost 40% reduction of the rHuEPO dose). The acyl/free carnitine ratio at baseline was the most contributing factor distinguishing responders from nonresponders. Conclusion: Although the beneficial effect of LC supplementation on renal anemia was not observed in all patients, at least 40% of the patients (responders) showed a significant improvement in ERI after long-term LC administration.

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Section: Discussioncontrasting

confidence: 53%

Long-Term Effects of Oral <smlcap>L</smlcap>-Carnitine Supplementation on Anemia in Chronic Hemodialysis

Kudoh¹,

Aoyama²,

Torii³

et al. 2014

Cardiorenal Med

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“…They cannot be extended to long-term dialysis patients with more profound carnitine deficiency (2,28). These carnitine-deficient patients have a higher risk for hyporesponsive rHuEPO-dependent anemia (28). Further studies must clarify whether these patients require carnitine supplementation.…”

Section: Discussionmentioning

confidence: 99%

L-Carnitine Treatment in Incident Hemodialysis Patients

Mercadal

Coudert²,

Vassault³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground L-carnitine levels decrease rapidly and steadily with duration of hemodialysis, and carnitine depletion can impair response to recombinant human erythropoietin (rHuEPO). The study hypothesis was that L-carnitine supplementation during the first year of hemodialysis would improve this response.Design, setting, participants, & measurements From October 2006 through March 2010, this multicenter, randomized, double-blinded study assigned 92 incident hemodialysis patients to receive placebo or 1 g of intravenous L-carnitine after each dialysis session for 1 year. The primary outcome measure compared the groups for rHuEPO resistance index (EPO-RI), defined as weekly rHuEPO doses (IU/kg body weight divided by hemoglobin level) (g/dl). ResultsIn the L-carnitine group, carnitine concentration increased from a mean 6 SD of 79651 mmol/L to 2586137 mmol/L; in the placebo group, it declined from 68625 mmol/L to 53624 mmol/L (interaction group 3 time, P,0.001). Carnitine deficiency affected about 30% of the patients in the placebo group during the study period. EPO-RI varied from 15.8611.3 to 9.565.8 IU/kg per g/dl in the placebo group and from 20.6612.8 to 15.6615.9 IU/kg per g/dl in the L-carnitine group, for a mean variation of 23.94612.5 IU/kg per g/dl and 22.98615.5 IU/kg per g/dl, respectively (P=0.7). After adjustment for baseline characteristics, the EPO-RI course was similar in each group (difference between groups, P=0.10; interaction group 3 time, P=0.9).Conclusions Carnitine levels decrease by about 11%633% during the first year of hemodialysis. Treatment of incident hemodialysis patients with L-carnitine does not improve their response to rHuEPO.

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“…(f) Angiotensin converting enzyme inhibitor (ACEI) class of drugs are also related to EPO resistance, as first reported by Reuter et al [38]. A study involving dialysis patients.…”

Section: Erythropoietin Resistancementioning

confidence: 91%