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Effect of l-carnitine therapy on patients in maintenance hemodialysis: a systematic review and meta-analysis

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Abstract

Background

l-Carnitine has been used as adjuvant therapy in hemodialysis (HD) patients for many years. However, there is controversy whether l-carnitine supplementation is beneficial. Therefore we performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of l-carnitine on HD patients.

Methods

RCTs of l-carnitine versus placebo for HD patients were searched from Medline, EMBASE and the Cochrane Central Register of Controlled Trials. We screened relevant studies according to predefined inclusion and exclusion criteria, and performed meta-analyses using Revman 5.1 software.

Results

Meta-analysis showed l-carnitine could not increase the total score of 36-item Short-Form Health Survey Questionnaire (SF-36) (SMD 0.76, 95 % CI −0.13 to 1.65, P = 0.09), and l-carnitine therapy did not improve serum C-reactive protein (SMD −0.37, 95 % CI −0.88 to 0.14, P = 0.16), oxidized low-density lipoprotein (SMD 0.04, 95 % CI −0.43 to 0.50, P = 0.87), albumin (SMD 0.25, 95 % CI −0.31 to 0.81, P = 0.38;), hemoglobin (SMD 0.23, 95 % CI −0.23 to 0.68, P = 0.33), cholesterol (SMD −0.24, 95 % CI −0.71 to 0.24, P = 0.33), triglycerides (SMD 0.02, 95 % CI −0.4 to 0.44, P = 0.91) or parathyroid hormone (SMD 0.21, 95 % CI −0.35 to 0.76, P = 0.46) levels.

Conclusions

There is no evidence that l-carnitine can improve the inflammation, oxidative stress, nutrition, anemia, dyslipidemia, hyperparathyroidism status or quality of life in HD patients. However, given methodological limitations and lack of hard endpoints, high-quality, long-term randomized trials are required to fully elucidate the clinical value of l-carnitine administration in hemodialysis patients.

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References

  1. Wolf AV, Remp DG, Kiley JE, Currie GD (1951) Artificial kidney function; kinetics of hemodialysis. J Clin Invest 30:1062–1070

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. de Mutsert R, Krediet RT (2006) Malnutrition, inflammation and atherosclerosis (MIA-syndrome) in dialysis patients. Ned Tijdschr Geneeskd 150:2023–2027

    PubMed  Google Scholar 

  3. Miller B, Ahmad S (2003) A review of the impact of l-carnitine therapy on patient functionality in maintenance hemodialysis. Am J Kidney Dis 41:S44–S48

    Article  CAS  PubMed  Google Scholar 

  4. Chilcot J (2012) The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes. Semin Dial 25:59–64

    Article  PubMed  Google Scholar 

  5. Cerretelli P, Marconi C (1990) l-carnitine supplementation in humans. The effects on physical performance. Int J Sports Med 11:1–14

    Article  CAS  PubMed  Google Scholar 

  6. Arduini A, Bonomini M, Savica V, Amato A, Zammit V (2008) Carnitine in metabolic disease: potential for pharmacological intervention. Pharmacol Ther 120:149–156

    Article  CAS  PubMed  Google Scholar 

  7. Rodriguez-Segade S, Alonso de la Pena C, Paz M et al (1986) Carnitine concentrations in dialysed and undialysed patients with chronic renal insufficiency. Ann Clin Biochem 23:671–675

    Article  PubMed  Google Scholar 

  8. Calò LA, Vertolli U, Davis PA, Savica V (2012) l carnitine in hemodialysis patients. Hemodial Int 16:428–434

    Article  PubMed  Google Scholar 

  9. Review Manager (RevMan) [Computer program]. The Nordic Cochrane Centre. Version 5.1. The Cochrane Collaboration 2011, Copenhagen

  10. Higgins JP. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration 2011. http://www.cochrane-handbook.org

  11. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  12. Fatouros IG, Douroudos I, Panagoutsos S et al (2010) Effects of l-carnitine on oxidative stress responses in patients with renal disease. Med Sci Sports Exerc 42:1809–1818

    Article  CAS  PubMed  Google Scholar 

  13. Ahmad S, Robertson HT, Golper TA et al (1990) Multicenter trial of l-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects. Kidney Int 38:912–918

    Article  CAS  PubMed  Google Scholar 

  14. Biolo G, Stulle M, Bianco F et al (2008) Insulin action on glucose and protein metabolism during l-carnitine supplementation in maintenance haemodialysis patients. Nephrol Dial Transplant 23:991–997

    Article  CAS  PubMed  Google Scholar 

  15. Brass EP, Adler S, Sietsema KE et al (2001) Intravenous l-carnitine increases plasma carnitine, reduces fatigue, and may preserve exercise capacity in hemodialysis patients. Am J Kidney Dis 37:1018–1028

    Article  CAS  PubMed  Google Scholar 

  16. Chazot C, Blanc C, Hurot JM, Charra B, Jean G, Laurent G (2003) Nutritional effects of carnitine supplementation in hemodialysis patients. Clin Nephrol 59:24–30

    Article  CAS  PubMed  Google Scholar 

  17. Cibulka R, Racek J, Pikner R et al (2007) Effect of l-carnitine supplementation on secondary hyperparathyroidism and bone metabolism in hemodialyzed patients. Calcif Tissue Int 81:99–106

    Article  CAS  PubMed  Google Scholar 

  18. Duranay M, Akay H, Yilmaz FM, Senes M, Tekeli N, Yücel D (2006) Effects of l-carnitine infusions on inflammatory and nutritional markers in haemodialysis patients. Nephrol Dial Transplant 21:3211–3214

    Article  CAS  PubMed  Google Scholar 

  19. Emami Naini A, Moradi M, Mortazavi M et al (2012) Effects of oral l-carnitine supplementation on lipid profile, anemia, and quality of life in chronic renal disease patients under hemodialysis: a randomized, double-blinded, placebo-controlled trial. J Nutr Metab 2012:510483

    Article  PubMed Central  PubMed  Google Scholar 

  20. Golper TA, Wolfson M, Ahmad S et al (1990) Multicenter trial of l-carnitine in maintenance hemodialysis patients. I. Carnitine concentrations and lipid effects. Kidney Int 38:904–911

    Article  CAS  PubMed  Google Scholar 

  21. Hakeshzadeh F, Tabibi H, Ahmadinejad M, Malakoutian T, Hedayati M (2010) Effects of l-carnitine supplement on plasma coagulation and anticoagulation factors in hemodialysis patients. Ren Fail 32:1109–1114

    Article  CAS  PubMed  Google Scholar 

  22. Mitwalli AH, Al-Wakeel JS, Alam A et al (2005) l-carnitine supplementation in hemodialysis patients. Saudi J Kidney Dis Transpl 16:17–22

    PubMed  Google Scholar 

  23. Rathod R, Baig MS, Khandelwal PN, Kulkarni SG, Gade PR, Siddiqui S (2006) Results of a single blind, randomized, placebo-controlled clinical trial to study the effect of intravenous l-carnitine supplementation on health-related quality of life in Indian patients on maintenance hemodialysis. Indian J Med Sci 60:143–153

    Article  PubMed  Google Scholar 

  24. Sabry AA (2010) The role of oral l-carnitine therapy in chronic hemodialysis patients. Saudi J Kidney Dis Transpl 21:454–459

    PubMed  Google Scholar 

  25. Sakurabayashi T, Miyazaki S, Yuasa Y et al (2008) l-carnitine supplementation decreases the left ventricular mass in patients undergoing hemodialysis. Circ J 72:926–931

    Article  CAS  PubMed  Google Scholar 

  26. Savica V, Santoro D, Mazzaglia G et al (2005) l-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients. J Ren Nutr 15:225–230

    Article  PubMed  Google Scholar 

  27. Shakeri A, Tabibi H, Hedayati M (2010) Effects of l-carnitine supplement on serum inflammatory cytokines, C-reactive protein, lipoprotein (a), and oxidative stress in hemodialysis patients with Lp (a) hyperlipoproteinemia. Hemodial Int 14:498–504

    Article  PubMed  Google Scholar 

  28. Shojaei M, Djalali M, Khatami M, Siassi F, Eshraghian M (2011) Effects of carnitine and coenzyme Q10 on lipid profile and serum levels of lipoprotein(a) in maintenance hemodialysis patients on statin therapy. Iran J Kidney Dis 5:114–118

    PubMed  Google Scholar 

  29. Signorelli SS, Fatuzzo P, Rapisarda F et al (2006) A randomised, controlled clinical trial evaluating changes in therapeutic efficacy and oxidative parameters after treatment with propionyl l-carnitine in patients with peripheral arterial disease requiring haemodialysis. Drugs Aging 23:263–270

    Article  CAS  PubMed  Google Scholar 

  30. Steiber AL, Davis AT, Spry L et al (2006) Carnitine treatment improved quality-of-life measure in a sample of Midwestern hemodialysis patients. JPEN J Parenter Enteral Nutr 30:10–15

    Article  CAS  PubMed  Google Scholar 

  31. Suchitra MM, Ashalatha VL, Sailaja E et al (2011) The effect of l-carnitine supplementation on lipid parameters, inflammatory and nutritional markers in maintenance hemodialysis patients. Saudi J Kidney Dis Transpl 22:1155–1159

    CAS  PubMed  Google Scholar 

  32. Tabibi H, Hakeshzadeh F, Hedayati M, Malakoutian T (2011) Effects of l-carnitine supplement on serum amyloid A and vascular inflammation markers in hemodialysis patients: a randomized controlled trial. J Ren Nutr 21:485–491

    Article  CAS  PubMed  Google Scholar 

  33. Thomas S, Fischer FP, Mettang T, Pauli-Magnus C, Weber J, Kuhlmann U (1999) Effects of l-carnitine on leukocyte function and viability in hemodialysis patients: a double-blind randomized trial. Am J Kidney Dis 34:678–687

    Article  CAS  PubMed  Google Scholar 

  34. Trovato GM, Iannetti E, Murgo AM, Carpinteri G, Catalano D (1998) Body composition and long-term levo-carnitine supplementation. Clin Ter 149:209–214

    CAS  PubMed  Google Scholar 

  35. Weschler A, Aviram M, Levin M, Better OS, Brook JG (1984) High dose of l-carnitine increases platelet aggregation and plasma triglyceride levels in uremic patients on hemodialysis. Nephron 38:120–124

    Article  CAS  PubMed  Google Scholar 

  36. Mercadal L, Coudert M, Vassault A et al (2012) l-carnitine treatment in incident hemodialysis patients: the multicenter, randomized, double-blinded, placebo-controlled CARNIDIAL trial. Clin J Am Soc Nephrol 7:1836–1842

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Bonomini M, Zammit V, Pusey CD, De Vecchi A, Arduini A (2011) Pharmacological use of l-carnitine in uremic anemia: has its full potential been exploited? Pharmacol Res 63:157–164

    Article  CAS  PubMed  Google Scholar 

  38. Hedayati SS (2006) Dialysis-related carnitine disorder. Semin Dial 19:323–328

    Article  PubMed  Google Scholar 

  39. Aleisa AM, Al-Majed AA, Al-Yahya AA et al (2007) Reversal of cisplatin-induced carnitine deficiency and energy starvation by propionyl-l-carnitine in rat kidney tissues. Clin Exp Pharmacol Physiol 34:1252–1259

    Article  CAS  PubMed  Google Scholar 

  40. Mingorance C, Rodriguez-Rodriguez R, Justo ML, Herrera MD, de Sotomayor MA (2011) Pharmacological effects and clinical applications of propionyl-l-carnitine. Nutr Rev 69:279–290

    Article  PubMed  Google Scholar 

  41. Yu J, Ye J, Liu X, Han Y, Wang C (2011) Protective effect of l-carnitine against H(2)O(2)-induced neurotoxicity in neuroblastoma (SH-SY5Y) cells. Neurol Res 33(7):708–716

    Article  CAS  PubMed  Google Scholar 

  42. Ribas GS, Biancini GB, Mescka C et al (2012) Oxidative stress parameters in urine from patients with disorders of propionate metabolism: a beneficial effect of l-carnitine supplementation. Cell Mol Neurobiol 32:77–82

    Article  CAS  PubMed  Google Scholar 

  43. Günal AI, Celiker H, Dönder E, Günal SY (1999) The effect of l-carnitine on insulin resistance in hemodialysed patients with chronic renal failure. J Nephrol 12:38–40

    PubMed  Google Scholar 

  44. Kitamura Y, Satoh K, Satoh T, Takita M, Matsuura A (2005) Effect of l-carnitine on erythroid colony formation in mouse bone marrow cells. Nephrol Dial Transplant 20:981–984

    Article  CAS  PubMed  Google Scholar 

  45. 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 

  46. Aslan D, Andersen MD, Gede LB et al (2012) Mechanisms for the bone anabolic effect of parathyroid hormone treatment in humans. Scand J Clin Lab Invest 72:14–22

    Article  CAS  PubMed  Google Scholar 

  47. Adamek G, Felix R, Guenther HL, Fleisch H (1987) Fatty acid oxidation in bone tissue and bone cells in culture. Characterization and hormonal influences. Biochem J 248:129–137

    CAS  PubMed Central  PubMed  Google Scholar 

  48. Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH (2011) Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken) 63(Suppl 11):S383–S412

    Article  Google Scholar 

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Acknowledgements

Supported by grants from the National Natural Sciences Foundation of China (81270812, 81100541), Ph.D programs foundation of ministry of Education of China (2011062110012). Furong Scholars Fund from Hunan Province Education Department.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Correspondence to Lin Sun.

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Yang, Sk., Xiao, L., Song, Pa. et al. Effect of l-carnitine therapy on patients in maintenance hemodialysis: a systematic review and meta-analysis. J Nephrol 27, 317–329 (2014). https://doi.org/10.1007/s40620-013-0002-7

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  • DOI: https://doi.org/10.1007/s40620-013-0002-7

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