The Response to Recombinant Human Erythropoietin in Patients with the Anemia of End-Stage Renal Disease Is Correlated with Serum Carnitine Levels

Kooistra, Menno P.; Struyvenberg, A; Es, Ad van

doi:10.1159/000186237

Cited by 60 publications

(39 citation statements)

References 9 publications

(10 reference statements)

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“…Impairment of the erythrocyte membrane by free radicals and the following hemolysis (besides erythropoietin deficiency) are among the main causes of anemia in hemodialysis patients [15, 16]. The dose of recombinant human erythropoietin negatively correlated with the L -carnitine plasma concentration [17], and the erythropoietin doses necessary for maintenance of a stable hematocrit could be reduced by almost twice in all patients supplemented with carnitine [8, 9]; the only exception were patients in whom an L -carnitine deficiency was not present [11, 18]. Our results correspond to the above-mentioned findings of other authors: hematocrit and hemoglobin concentration showed a tendency to increase, although the erythropoietin doses were significantly reduced.…”

Section: Discussionmentioning

confidence: 99%

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

Veselá¹,

Ráček

Trefil

et al. 2001

Nephron

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Background/Aim:L-Carnitine is important in β-oxidation of fatty acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and especially by its loss during dialysis. The aim of our study was to test the influence of carnitine supplementation on plasma lipids, red blood cell count, and metabolism of free radicals. Methods: Twelve regularly dialyzed patients (average age 55.5 years, average dialysis treatment period 22.5 months) were given 15 mg/kg L-carnitine intravenously three times weekly (after each hemodialysis session) for 6 months. Laboratory markers of oxidative stress, lipid metabolism, and red blood cell count were measured before the supplementation and then controlled during two 3-month intervals. Nine patients were retested 3 months after the supplementation had ended. Results: All supplemented patients showed increased plasma free carnitine in comparison with the pretreatment values (113.3 ± 11.2 vs. 62.3 ± 16.7 µmol/l, p < 0.001). The proportion of decreased L-carnitine values after hemodialysis was reduced from 79 to 22%. Plasma total cholesterol (4.66 ± 0.30 mmol/l after treatment vs. 5.65 ± 1.53 mmol/l before treatment, p < 0.05) and LDL cholesterol (1.74 ± 0.86 vs. 2.81 ± 1.43 mmol/l, p < 0.05) decreased. The albumin concentration significantly increased from 34.8 ± 7.3 to 46.0 ±5.4 g/l (p < 0.05). Intraerythrocyte reduced glutathione increased from 1.65 ± 0.25 to 2.23 ± 0.16 mmol/l (p < 0.001), and the plasma antioxidant capacity increased from 1.65 ± 0.09 to 2.06 ± 0.17 mmol/l (p < 0.001). At the same time, plasma malondialdehyde decreased from 4.18 ± 0.72 to 3.07 ± 0.35 µmol/l (p < 0.001). The erythropoietin dose could be reduced from an average value of 5,500 to 3,500 U/week. No significant changes in the above-mentioned parameters were observed in a control group of dialyzed patients without L-carnitine supplementation. Conclusion: Regular carnitine supplementation of hemodialysis patients can improve their lipid metabolism, protein nutrition, red blood cell count, and antioxidant status.

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Section: Discussionmentioning

confidence: 99%

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

Veselá¹,

Ráček

Trefil

et al. 2001

Nephron

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“…Carnitine may improve anemia in hemodialysis patients with EPO resistance [182] by mechanisms not yet known [183] , or stabilizing the membrane as an antioxidant agent, or by stimulating erythropoiesis, by the increase in the number of reticulocytes demonstrated in some patients on hemodialysis treated with L-carnitine [184] . The dose used in patients with EPO resistence is 1 g iv posthemodialysis [185] .…”

Section: Resistancementioning

confidence: 99%

Use of agents stimulating erythropoiesis in digestive diseases

López¹,

Sicilia²,

García³

2009

WJG

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Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron deficiency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as first choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same efficacy and safety.

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“…Later, in ESA-treated patients, Kooistra and colleagues observed that the total LC and free levels demonstrated an inverse relationship with hematocrit in maintenance hemodialysis patients (16). In their study, LC demonstrated a beneficial effect in patients with hematocrit ,30%.…”

mentioning

confidence: 92%

L-Carnitine for Anemia in Hemodialysis Patients

Yee

2012

Clinical Journal of the American Society of Nephrology

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The Response to Recombinant Human Erythropoietin in Patients with the Anemia of End-Stage Renal Disease Is Correlated with Serum Carnitine Levels

Cited by 60 publications

References 9 publications

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

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

Use of agents stimulating erythropoiesis in digestive diseases

L-Carnitine for Anemia in Hemodialysis Patients

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