Effects of L-Carnitine Supplementation in Patients Receiving Hemodialysis or Peritoneal Dialysis

Masako Kuwasawa-Iwasaki, Hiroaki Io, Masahiro Muto, Saki Ichikawa, Keiichi Wakabayashi, Reo Kanda, Junichiro Nakata, Nao Nohara, Yasuhiko Tomino, Yusuke Suzuki, Masako Kuwasawa-Iwasaki, Hiroaki Io, Masahiro Muto, Saki Ichikawa, Keiichi Wakabayashi, Reo Kanda, Junichiro Nakata, Nao Nohara, Yasuhiko Tomino, Yusuke Suzuki

Abstract

L-carnitine is an important factor in fatty acid metabolism, and carnitine deficiency is common in dialysis patients. This study evaluated whether L-carnitine supplementation improved muscle spasm, cardiac function, and renal anemia in dialysis patients. Eighty Japanese outpatients (62 hemodialysis (HD) patients and 18 peritoneal dialysis (PD) patients) received oral L-carnitine (600 mg/day) for 12 months; the HD patients further received intravenous L-carnitine injections (1000 mg three times/week) for 12 months, amounting to 24 months of treatment. Muscle spasm incidence was assessed using a questionnaire, and cardiac function was assessed using echocardiography. Baseline free carnitine concentrations were relatively low in patients who underwent dialysis for >4 years. Total carnitine serum concentration, free carnitine, and acylcarnitine significantly increased after oral L-carnitine treatment for 12 months, and after intravenous L-carnitine injection. There was no significant improvement in muscle spasms, although decreased muscle cramping after L-carnitine treatment was reported by 31% of patients who had undergone HD for >4 years. Hemoglobin concentrations increased significantly at 12 and 24 months in the HD group. Therefore, L-carnitine may be effective for reducing muscle cramping and improving hemoglobin levels in dialysis patients, especially those who have been undergoing dialysis for >4 years.

Keywords: L-carnitine; hemodialysis; muscle spasm; peritoneal dialysis; renal anemia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Baseline carnitine concentrations according to dialysis durations ranging from (a) <1 year, (b) 1–4 years, and (c) >4 years. Free carnitine (FC) concentrations were lower than total carnitine (TC) concentrations. AC: acyl carnitine. Normal serum concentrations were 45–91 µmol/L for TC, 36–74 µmol/L for FC, and 6–23 µmol/L for AC.
Figure 2
Figure 2
(a) Baseline concentrations of total carnitine (TC), free carnitine (FC), and acylcarnitine (AC) according to dialysis duration. (b) According to dialysis duration, FC concentrations at baseline revealed low baseline FC concentrations for patients with a hemodialysis (HD) duration of more than 4 years. (c) Baseline carnitine levels concentrations, according to peritoneal dialysis (PD) duration. (d) Changes in carnitine concentrations during l-carnitine treatment, which revealed significant TC, FC, and AC increases.
Figure 3
Figure 3
Survey responses regarding changes in muscle spasms according to dialysis durations of (a) ≤4 years and (b) >4 years. The proportion of patients who reported that leg cramps had been cured was substantially larger among patients who had undergone dialysis for >year.
Figure 4
Figure 4
(a) Effects of l-carnitine treatment on hemoglobin concentrations, which significantly increased after 12 months and 24 months in HD patients. (b) The levels of ERI in HD patients. (c) Use of ESA dose in HD patients. (d) The levels of Hb in PD patients. (e) The levels of ERI in PD patiemts. (f) Use of ESA dose in PD patients.
Figure 5
Figure 5
Treatment using l-carnitine did not significantly reduce the average erythropoietin resistance index (a) or erythropoiesis-stimulating agents (ESA) dose (b). ESA: erythropoiesis-stimulating agents, ERI: erythropoietin resistance index ([epoetin dose]/[body weight]/[hemoglobin concentration]).
Figure 6
Figure 6
Carnitine administration significantly increased blood carnitine levels in both HD (a–c) and PD patients (d–f).

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Source: PubMed

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