Journal Article

Effects of Reducing L-Carnitine Supplementation on Carnitine Kinetics and Cardiac Function in Hemodialysis Patients: A Multicenter, Single-Blind, Placebo-Controlled, Randomized Clinical Trial

Miki Sugiyama, Yusuke Kaida, Goh Kodama, Yuka Kurokawa, Kei Fukami, Tomofumi Moriyama, Ryuji Iwatani, Yoshifumi Wada, Takuya Ariyoshi, Ryo Shibata, Kaoru Nakano, Junko Yano, Takuma Hazama, Yoshihiko Otsubo, Kyoko Tashiro, Kengo Urae, Makoto Nasu, Yukie Kinoshita

2021

Overview

L-carnitine (LC) supplementation improves cardiac function in hemodialysis (HD) patients. However, whether reducing LC supplementation affects carnitine kinetics and cardiac function in HD patients treated with LC remains unclear. Fifty-nine HD patients previously treated with intravenous LC 1000 mg per HD session (three times weekly) were allocated to three groups: LC injection three times weekly, once weekly, and placebo, and prospectively followed up for six months. Carnitine fractions were assessed by enzyme cycling methods. Plasma and red blood cell (RBC) acylcarnitines were profiled using tandem mass spectrometry. Cardiac function was evaluated using echocardiography and plasma B-type natriuretic peptide (BNP) levels. Reducing LC administration to once weekly significantly decreased plasma carnitine fractions and RBC-free carnitine levels during the study period, which were further decreased in the placebo group (p < 0.001). Plasma BNP levels were significantly elevated in the placebo group (p = 0.03). Furthermore, changes in RBC (C16 + C18:1)/C2 acylcarnitine ratio were positively correlated with changes in plasma BNP levels (β = 0.389, p = 0.005). Reducing LC administration for six months significantly decreased both plasma and RBC carnitine levels, while the full termination of LC increased plasma BNP levels; however, it did not influence cardiac function in HD patients.

• Publisher: MDPI AG,MDPI
• Subject: acylcarnitine / Aged / brain natriuretic peptide / Cardiac function / cardiac output / cardiomyopathy / Carnitine / carnitine deficiency / Clinical trials / CPT2 / Dietary Supplements / Dose-Response Relationship, Drug / echocardiography / end-stage kidney disease / Enzymes / erythrocytes / Fatty acids / Female / Flow velocity / Follow-Up Studies / free fatty acid / Heart / heart failure / Hemodialysis / Humans / intravenous injection / Kidney Failure, Chronic / Levocarnitine / Male / Mass spectrometry / Middle Aged / Natriuretic peptides / placebos / Plasma / Prospective Studies / Renal Dialysis / Restless legs syndrome / Scientific imaging / Single-Blind Method / tandem mass spectrometry