The Effect of Oral L-carnitine on Serum Albumin and Inflammatory Markers Levels in Patients under Peritoneal Dialysis: A Randomized Controlled Trial

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Nephrology, Isfahan Kidney Disease Center, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

3 General Practitioner, Research, Student Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

4 Nurse, Peritoneal Dialysis Center, Isfahan Kidney Disease Center, Isfahan University of Medical Science, Isfahan, Iran.

Abstract

Background: Malnutrition is one of the most common complications among patients under maintenance dialysis which is related to systemic inflammatory processes. Decrease in serum albumin level, following malnutrition, is an independent risk factor for cardio-vascular diseases in patients under dialysis. We aimed to evaluate the effect of oral L-Carnitine supplementation on serum albumin and inflammatory factors (C reactive protein (CRP) and hemosysteine) in patients under peritoneal dialysis.Methods: This randomized, double-blind, placebo-controlled trial was conducted on 48 patients under peritoneal dialysis referring to Isfahan Peritoneal Dialysis Center from 2009-2010. Patients were randomized to carnitine and placebo groups and received oral carnitine (250 mg, 3 tablets /day) or placebo for 9 months. Serum albumin level was checked every 3 months and serum CRP and hemosysteine levels were checked before and after the study and compared between the two groups.Finding: Compared to placebo group, serum albumin level was increased significantly from 3.30 ± 0.51 to 3.70 ± 0.53 mg/dl (P = 0.044). In carnitine group, serum CRP level was increased from 2.35 ± 2.49 to 3.37 ± 4.80 mg/l (P = 0.304) while in the placebo group it was significantly increased from 1.37 ± 1.28 to 2.44 ± 2.68 mg/l (P = 0.039). In contrast, serum hemosysteine level was significantly increased in the carnitine group from 21.40 ± 8.08 to 25.70 ± 6.85 µgr/l (P = 0.019) while its increase in the placebo groop was not significant (P = 0.159). One patient in the carnitine group with history of hypertension experienced an increase in blood pressure that was controlled with a greater dose of anti-hypertensive drugs. Conclusion: In patients under peritoneal dialysis, oral L-carnitine can increase serum albumin level and prevent CRP rising, but has no beneficial effect on hemosysteine. According to several reports on beneficial effects of L-carnitine on anemia and lipid profile in patients under dialysis, its supplementation is recommended for these patients. 

Keywords

References

  1. Hosseinpanah F, Kasraei F, Nassiri AA, Azizi F. High prevalence of chronic kidney disease in Iran: a large population-based study. BMC Public Health 2009; 9: 44.
  2. Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi FF, et al. Malnutrition in hemodialysis patients: what therapy? Am J Kidney Dis 2005; 46(3): 371-86.
  3. Poole R, Hamad A. Nutrition supplements in dialysis patients: use in peritoneal dialysis patients and diabetic patients. Adv Perit Dial 2008; 24: 118-24.
  4. Wojcik K, Stompor T, Krzanowski M, Miarka P, Zdzienicka A, Sulowicz W. The relationships between activation of non-specific inflammatory process and malnutrition in patients on peritoneal dialysis. Med Pregl 2007; 60 (Suppl 2): 114-6.
  5. De Mutsert R, Grootendorst DC, Indemans F, Boeschoten EW, Krediet RT, Dekker FW. Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr 2009; 19(2): 127-35.
  6. Ferrari R, Merli E, Cicchitelli G, Mele D, Fucili A, Ceconi C. Therapeutic effects of L-carnitine and propionyl-L-carnitine on cardiovascular diseases: a review. Ann N Y Acad Sci 2004; 1033: 79-91.
  7. Savica V, Santoro D, Mazzaglia G, Ciolino F, Monardo P, Calvani M, et al. L-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients. J Ren Nutr 2005; 15(2): 225-30.
  8. Bellinghieri G, Santoro D, Calvani M, Savica V. Role of carnitine in modulating acute-phase protein synthesis in hemodialysis patients. J Ren Nutr 2005; 15(1): 13-7.
  9. Signorelli SS, Fatuzzo P, Rapisarda F, Neri S, Ferrante M, Oliveri CG, et al. Propionyl-L-carnitine therapy: effects on endothelin-1 and homocysteine levels in patients with peripheral arterial disease and end-stage renal disease. Kidney Blood Press Res 2006; 29(2): 100-7.
  10. Calo LA, Pagnin E, Davis PA, Semplicini A, Nicolai R, Calvani M, et al. Antioxidant effect of L-carnitine and its short chain esters: relevance for the protection from oxidative stress related cardiovascular damage. Int J Cardiol 2006; 107(1): 54-60.
  11. Arduini A, Bonomini M, Savica V, Amato A, Zammit V. Carnitine in metabolic disease: potential for pharmacological intervention. Pharmacol Ther 2008; 120(2): 149-56.
  12. Steinman TI. L-carnitine supplementation in dialysis patients: does the evidence justify its use? Semin Dial 2005; 18(1): 1-2.
  13. Bostom AG, Lathrop L. Hyperhomocysteinemia in end-stage renal disease: prevalence, etiology, and potential relationship to arteriosclerotic outcomes. Kidney Int 1997; 52(1): 10-20.
  14. Chazot C, Blanc C, Hurot JM, Charra B, Jean G, Laurent G. Nutritional effects of carnitine supplementation in hemodialysis patients. Clin Nephrol 2003; 59(1): 24-30.
  15. Retter AS. Carnitine and its role in cardiovascular disease. Heart Dis 1999; 1(2): 108-13.
  16. El Metwally TH, Hamed EA, Ahmad AR, Mohamed NA. Dyslipidemia, oxidative stress and cardiac dysfunction in children with chronic renal failure: effects of L-carnitine supplementation. Ann Saudi Med 2003; 23(5): 270-7.
  17. Vesela E, Racek J, Trefil L, Jankovy'ch V, Pojer M. Effect of L-carnitine supplementation in hemodialysis patients. Nephron 2001; 88(3): 218-23.
  18. Duranay M, Akay H, Yilmaz FM, Senes M, Tekeli N, Yucel D. Effects of L-carnitine infusions on inflammatory and nutritional markers in haemodialysis patients. Nephrol Dial Transplant 2006; 21(11): 3211-4.
  19. Kalantar-Zadeh K, Braglia A, Chow J, Kwon O, Kuwae N, Colman S, et al. An anti-inflammatory and antioxidant nutritional supplement for hypoalbuminemic hemodialysis patients: a pilot/feasibility study. J Ren Nutr 2005; 15(3): 318-31.
Journal of Isfahan Medical School
Volume 29, Issue 138 - Serial Number 138
March and April 2011
Pages 546-554

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History

  • Receive Date: 21 November 2010
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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