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      Effects of L-Carnitine Supplementation on Renal Anemia in Poor Responders to Erythropoietin


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          While renal anemia can be successfully treated by use of erythropoietin (EPO) in most hemodialysis (HD) patients, some patients have anemia that is refractory to treatment with a high dose of EPO. We examined whether L-carnitine treatment could raise hematocrit (Hct) levels in such patients. Fourteen HD patients who showed a poor response to EPO and no evident factors which inhibit a response to EPO were selected to receive oral L-carnitine (500 mg/day) in a 3-month trial. During the study, 36% of the patients showed Hct increases of more than 2%. Statistical analysis revealed significant increases of Hct (p = 0.003) and total iron-binding capacity (TIBC) (p = 0.050) and a significant decrease of ferritin (p = 0.005). In addition, we found that red blood cells (RBCs) in HD patients contained a comparable level of carnitine to normal controls, despite the presence of serum carnitine deficiency, and that RBC carnitine was not removed through HD, in contrast to serum carnitine. These results suggest that RBC carnitine may be essential for RBCs to perform their metabolic function in renal anemia and that oral L-carnitine treatment could improve anemia in poor responders to EPO.

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          Most cited references3

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          Effect of L-carnitine and acetyl-L-carnitibe on the human erythrocyte membrane stability and deformability

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            Carnitine levels in human serum in health and disease

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              Addition of L-carnitine to additive solution-suspended red cells stored at 4 degrees C reduces in vitro hemolysis and improves in vivo viability.

              The role of L-carnitine (LC) as the requisite carrier of long-chain fatty acids into mitochondria is well established. Human red cells (RBCs), which lack mitochondria, possess a substantial amount of LC and its esters. In addition, carnitine palmitoyl transferase, an enzyme that catalyzes the reversible transfer of the acyl moiety from acyl-coenzyme A to LC is found in RBCs. It has recently been shown that LC and carnitine palmitoyl transferase play a major role in modulating the pathway for the turnover of membrane phospholipid fatty acids in intact human RBCs, and that LC improved the membrane stability of RBCs subjected to high shear stress. RBC membrane lesions occur during storage at 4 degrees C; this study investigated whether the addition of LC (5 mM) to a standard RBC preservative solution (AS-3) affected cellular integrity with 42 days' storage.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                08 December 2000
                : 19
                : 1
                : 24-32
                aDepartment of Hemodialysis, Chukyo Hospital, Nagoya; bDepartment of Pediatrics, School of Medicine, Fukuoka University, Fukuoka; cMeiyo Clinic, Toyohashi; dDepartment of Nephrology, The Branch Hospital, Toranomon Hospital, Kawasaki, and eKomaki Clinic, Komaki, Japan
                14474 Blood Purif 2001;19:24–32
                © 2001 S. Karger AG, Basel

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                Page count
                Figures: 6, Tables: 1, References: 38, Pages: 9
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/14474
                Self URI (text/html): https://www.karger.com/Article/FullText/14474
                Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
                Original Paper

                Cardiovascular Medicine,Nephrology
                Hemodialysis,<italic>L</italic>-Carnitine supplementation,Renal anemia,Erythropoietin


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