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      Long-Term Effects of Oral L-Carnitine Supplementation on Anemia in Chronic Hemodialysis

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          Abstract

          Background: The therapeutic role of <smlcap>L</smlcap>-carnitine (LC) on the anemia of chronic hemodialized patients is still controversial. In order to clarify the long-term effects of LC administration on renal anemia, an open, observational 12-month study was performed. Methods: Twenty stable outpatients undergoing hemodialysis were administered LC 900 mg p.o. daily for 12 months. The recombinant human erythropoietin (rHuEPO) dose was adjusted monthly when necessary to maintain the target hemoglobin (Hb) levels. Results: The free LC level increased, while the acyl/free LC ratio decreased significantly 3 months after administration and was then maintained until the end of the study. There was no difference in Hb levels and the erythropoietin resistance index (ERI) during the study period. However, it was observed that ERI decreased significantly in 7 out of 18 patients (responders) 5 months after LC administration and was maintained thereafter (almost 40% reduction of the rHuEPO dose). The acyl/free carnitine ratio at baseline was the most contributing factor distinguishing responders from nonresponders. Conclusion: Although the beneficial effect of LC supplementation on renal anemia was not observed in all patients, at least 40% of the patients (responders) showed a significant improvement in ERI after long-term LC administration.

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          Most cited references 21

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          Carnitine and Acylcarnitines

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            Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s).

            The kidney disease improving global outcomes (KDIGO) clinical practice guideline for anemia in chronic kidney disease (CKD) is designed to assist health-care providers in treating CKD patients with anemia. A guideline is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. It is intended to provide information and to allow the practitioner to make an informed decision, based on evidence and expert judgment. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in any particular clinical situation. Owing to the general nature of a guideline, it is sometimes difficult to translate it to an individual patient's condition. As the primary goal is to improve patient care, we have decided to focus on practical clinical aspects of the KDIGO anemia guideline.
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              L-carnitine effects on anemia in hemodialyzed patients treated with erythropoietin.

               W D Labonia (1995)
              To demonstrate whether L-carnitine treatment could further improve the anemia in dialyzed patients under recombinant human erythropoietin (r-HuEPO) therapy, leading to a reduction in r-HuEPO requirements, L-carnitine (1 g intravenously after every dialysis session) was administered for 6 months to a group of 13 patients; the results were compared with data from a placebo control group (N = 11). Globular osmotic fragility and endogenous EPO secretion were also evaluated. L-Carnitine treatment promoted a 38.1% reduction in r-HuEPO requirements in the active group (102.2 +/- 52.6 U/kg/wk v 63.3 +/- 37.8 U/kg/wk; P < 0.02), with globular osmotic fragility and endogenous EPO levels remaining unchanged and thus not accounting for carnitine effect on anemia. In the active group, seven patients decreased r-HuEPO needs (responders), while six did not (nonresponders). Compared with nonresponders, responders showed higher mean values at time 0 for r-HuEPO requirements and endogenous plasma EPO levels, although not statistically significant. It is concluded that L-carnitine deficiency might promote EPO resistance in dialyzed patients, which is corrected by L-carnitine supplementation, ultimately reducing r-HuEPO requirements.
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                Author and article information

                Journal
                CRM
                Cardiorenal Med
                10.1159/issn.1664-5502
                Cardiorenal Medicine
                S. Karger AG
                1664-3828
                1664-5502
                2014
                April 2014
                21 March 2014
                : 4
                : 1
                : 53-59
                Affiliations
                Kidney Center, Sapporo South One Hospital, Sapporo, Japan
                Author notes
                *Yasuo Kudoh, MD, Kidney Center, Sapporo South One Hospital, S1W13, Chuou-ku, Sapporo 060-0061 (Japan), E-Mail yasuo0302@view.ocn.ne.jp
                Article
                360865 PMC4024502 Cardiorenal Med 2014;4:53-59
                10.1159/000360865
                PMC4024502
                24847334
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 2, Pages: 7
                Categories
                Original Paper

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