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Effects of Reducing L-Carnitine Supplementation on Carnitine Kinetics and Cardiac Function in Hemodialysis Patients:

Miki Sugiyama1,2, Takuma Hazama1, Kaoru Nakano1

  • 1Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.

Nutrients
|June 2, 2021
PubMed

Insights

Reducing L-carnitine (LC) in hemodialysis patients lowered carnitine levels. While stopping LC increased a cardiac marker, overall cardiac function remained unaffected in this six-month study.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • L-carnitine (LC) supplementation is known to improve cardiac function in hemodialysis (HD) patients.
  • The impact of reduced LC supplementation on carnitine kinetics and cardiac function in HD patients previously treated with LC is not well understood.

Purpose of the Study:

  • To investigate the effects of decreasing L-carnitine (LC) administration frequency on carnitine levels and cardiac function in hemodialysis (HD) patients.
  • To assess the correlation between carnitine profiles and cardiac biomarkers after altering LC supplementation.

Main Methods:

  • Fifty-nine HD patients on intravenous LC were randomized into three groups: thrice weekly, once weekly, or placebo for six months.
  • Carnitine fractions were measured using enzyme cycling; plasma and red blood cell (RBC) acylcarnitines were profiled via tandem mass spectrometry.
  • Cardiac function was assessed using echocardiography and plasma B-type natriuretic peptide (BNP) levels.

Main Results:

  • Reducing LC administration to once weekly significantly decreased plasma carnitine and RBC-free carnitine levels.
  • The placebo group showed further decreases in carnitine levels (p < 0.001) and significantly elevated plasma BNP levels (p = 0.03).
  • Changes in the RBC (C16 + C18:1)/C2 acylcarnitine ratio correlated positively with plasma BNP changes (β = 0.389, p = 0.005).

Conclusions:

  • Six months of reduced LC administration significantly lowered plasma and RBC carnitine levels in HD patients.
  • Complete cessation of LC increased plasma BNP levels but did not adversely affect cardiac function.
  • These findings suggest a need for careful consideration of LC dosing strategies in HD patients.

Keywords:
CPT2acylcarnitinebrain natriuretic peptidecardiac functioncardiomyopathycarnitine deficiencyend-stage kidney diseasefree fatty acidheart failurehemodialysis

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