Skip to main content

Advertisement

SpringerLink
Log in

Effect of carnitine supplementation on lipid profile and anemia in children on chronic dialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

We prospectively evaluated the effects of L-carnitine supplementation on plasma free carnitine (FC) levels, serum lipid profile, and erythropoietin (rhEPO) requirement in 24 children treated with peritoneal dialysis (PD; n = 16) or hemodialysis (HD; n = 8). The study was divided into a 3-month observation period, and a 3-month treatment period during which patients received 20 mg/kg per day of L-carnitine given orally. Clinical, biochemical, and hematological data were collected every 3 months. FC levels were measured in plasma and peritoneal dialysate by tandem mass spectrometry. There were no statistically significant changes in lipid levels, hemoglobin, or rhEPO requirements during the course of the study. Fifteen patients (13 PD, 2 HD) had plasma FC levels measured before and after treatment; FC levels increased from 32.1 ± 14.1 μmol/l to 80.9 ± 38.7 μmol/l (P < 0.001). In PD patients, dialysate FC losses increased from 106 ± 78 μmol/day at baseline to 178 ± 119 μmol/day after supplementation. Positive correlations between FC plasma levels and dialysate levels (R = 0.507) or daily excretion (R = 0.603) were found after treatment. In our case series, an oral dose of 20 mg/kg per day of L-carnitine restored FC levels and produced a positive carnitine balance with no significant effects on hematological parameters or lipid profile over a 3-month period. Prolonged treatment duration may be required to obtain significant results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Guarnieri G, Situlin R, Biolo G (2001) Carnitine metabolism in uremia. Am J Kidney Dis 38:S63–S67

    Article  CAS  Google Scholar 

  2. Hoppel C (2003) The role of carnitine in normal and altered fatty acid metabolism. Am J Kidney Dis 41:S4–S12

    Article  CAS  Google Scholar 

  3. Eknoyan G, Latos DL, Lindberg J (2003) Practice recommendations for the use of L-carnitine in dialysis-related carnitine disorder. National Kidney Foundation Carnitine Consensus Conference. Am J Kidney Dis 41:868–876

    Article  Google Scholar 

  4. Hurot JM, Cucherat M, Haugh M, Fouque D (2002) Effects of L-carnitine supplementation in maintenance hemodialysis patients: a systematic review. J Am Soc Nephrol 13:708–714

    CAS  PubMed  Google Scholar 

  5. Winchester JF (2000) L-carnitine and peritoneal dialysis. Perit Dial Int 20:S150–S153

    PubMed  Google Scholar 

  6. National Kidney Foundation (2000) K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 35:S54–S55

    Google Scholar 

  7. Schröder CH (2003) The management of anemia in pediatric peritoneal dialysis patients. Guidelines by an ad hoc European committee. Pediatr Nephrol 18:805–809

    Article  Google Scholar 

  8. Schreiber BD (2006) Debate forum: levocarnitine therapy is rational and justified in selected dialysis patients. Blood Purif 24:128–139

    Article  CAS  Google Scholar 

  9. Belay B, Esteban-Cruciani N, Walsh CA, Kaskel FJ (2006) The use of levo-carnitine in children with renal disease: a review and a call for future studies. Pediatr Nephrol 21:308–317

    Article  Google Scholar 

  10. Warady BA, Borum P, Stall C, Millspaugh J, Taggart E, Lum G (1990) Carnitine status of pediatric patients on continuous ambulatory peritoneal dialysis. Am J Nephrol 10:109–114

    Article  CAS  Google Scholar 

  11. Kosan C, Sever L, Arisoy N, Cahskan S, Kasapcopur O (2003) Carnitine supplementation improves apolipoprotein B levels in pediatric peritoneal dialysis patients. Pediatr Nephrol 18:1184–1188

    Article  Google Scholar 

  12. Lilien MR, Duran M, Quark JME, Frankuisen JJ, Schröder CH (2000) Oral L-carnitine does not decrease erythropoietin requirement in pediatric dialysis. Pediatr Nephrol 15:17–20

    Article  CAS  Google Scholar 

  13. Murakomi R, Momota T, Yoshiya K, Yoshikawa N, Nakamura H, Honda M, Ito H (1990) Serum carnitine and nutritional status in children treated with continuous ambulatory peritoneal dialysis. J Pediatr Gastroenterol Nutr 11:371–374

    Article  Google Scholar 

  14. Zachwieja J, Duran M, Joles JA, Allers PJ, van de Hurk D, Frankhuisen JJ, Donckerwolcke RA (1994) Amino acid and carnitine supplementation in haemodialysed children. Pediatr Nephrol 8:739–743

    Article  CAS  Google Scholar 

  15. Soldin OP, Bierbower LH, Chai JJ, Choi JJ, Thompson-Hoffmann S, Soldin SJ (2004) Serum iron, ferritin, total iron binding capacity, hs-CRP, LDL cholesterol and magnesium in children; new reference intervals using the Dade Dimension Clinical Chemistry System. Clin Chim Acta 342:211–217

    Article  CAS  Google Scholar 

  16. Centers for Medicare & Medicaid Services (2002) Levocarnitine for use in the treatment of carnitine deficiency in ESRD patients. Transmittal AB-02-165. Baltimore: Department of Health and Human Services, Centers for Medicare & Medicaid Services. November

  17. Kletzmayr J, Mayer G, Legenstein E, Heinz-Peer G, Leitha T, Horl WH, Kovarik J (1999) Anemia and carnitine supplementation in hemodialyzed patients. Kidney Int 69:S93–S106

    Article  CAS  Google Scholar 

  18. Constantin-Teodosiu D, Kirby DPJ, Short AH, Burden RP, Morgan AG, Greenhaff PL (1996) Free and esterified carnitine in continuous ambulatory peritoneal dialysis patients. Kidney Int 49:158–162

    Article  CAS  Google Scholar 

  19. Vacha GM, Giorcelli G, Siliprandi N, Corsi M (1983) Favorable effects of L-carnitine treatment on hypertrigliceridemia in hemodialysis patients. Decisive role of low levels of high-density lipoprotein-cholesterol. Am J Clin Nutr 38:532–540

    Article  CAS  Google Scholar 

  20. Berard E, Iordache A (1992) Effect of low doses of L-carnitine on the response to recombinant human erythropoietin in hemodialyzed children: about two cases. Nephron 62:368–369

    Article  CAS  Google Scholar 

  21. KDOQI; National Kidney Foundation (2006) III. Clinical practice recommendations for anemia in chronic kidney disease in children. Am J Kidney Dis 47(Suppl 3):S86–S108

    Google Scholar 

  22. Mir S, Kantar M, Yalaz M, Keskinoglu AI, Sil C, Huseyinov A (2002) Effect of hemodialysis on carnitine levels in children with chronic renal failure. Pediatr Int 44:70–73

    Article  CAS  Google Scholar 

  23. Chatzdimitriou C, Pliakogiannis T, Evangeliou A, Tsalkidou T, Böhles HJ, Kalaitzidis K (1992) Evaluation of carnitine levels according to the peritoneal equilibration test in patients on continuous ambulatory peritoneal dialysis. Perit Dial Int 13(Suppl 2):S444–S447

    Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from Sigma Tau, Italy. The authors wish to thank Dr. Anna Capurro for English revision and Mrs. Daniela Accerbis for manuscript preparation.

Author information

Authors and Affiliations

  1. Nephrology and Dialysis Unit, G. Gaslini Institute, Largo G. Gaslini, 5, 16148, Genova, Italy

    Enrico Verrina, Laura Turrini Dertenois & Francesco Perfumo

  2. Laboratory for the Study of Inborn Errors of Metabolism - University Department of Pediatrics, G. Gaslini Institute, Genoa, Italy

    Ubaldo Caruso, Michela Cassanello & Roberto Cerone

  3. Epidemiology and Biostatistics Unit, G. Gaslini Institute, Genoa, Italy

    Maria Grazia Calevo

  4. Nephrology and Dialysis Unit, Bambino Gesù Children’s Hospital, Rome, Italy

    Francesco Emma

  5. Nephrology and Dialysis Unit, Giovanni XXIII Children’s Hospital, Bari, Italy

    Palma Sorino & Tommaso De Palo

  6. Nephrology and Dialysis Unit, Meyer Children’s Hospital, Florence, Italy

    Giancarlo Lavoratti

Authors
  1. Enrico Verrina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ubaldo Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Grazia Calevo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Emma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Palma Sorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tommaso De Palo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giancarlo Lavoratti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Laura Turrini Dertenois
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michela Cassanello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberto Cerone
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesco Perfumo
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Italian Registry of Pediatric Chronic Dialysis

Corresponding author

Correspondence to Enrico Verrina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verrina, E., Caruso, U., Calevo, M.G. et al. Effect of carnitine supplementation on lipid profile and anemia in children on chronic dialysis. Pediatr Nephrol 22, 727–733 (2007). https://doi.org/10.1007/s00467-006-0408-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-006-0408-8

Keywords

Search

Navigation