Carnitine in HD Patients: An Update by ProQuest


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      42 Renal & Urology News                OCTOBER 2009                                                                                                                    

                                                        RENAL NUTRITION UPDATE

           Carnitine in HD Patients: An Update
           Carnitine treatment can improve erythropoietin resistance and other parameters
           BY ALISON STEIBER, PhD, RD, LD                                                                                                                                          tine group had improved sensi-
           CARNITINE, a 3-hydroxy-4-N-                                                                                                                                             tivity as measured by a euglycemic
           trimethylammoniobutanoate, is a                                                                                                                                         insulin-clamp procedure. Addition-
           small, water soluble molecule found                                                                                                                                     ally, this study used the stable
           in most cells of the body. The renal                                                                                                                                    isotope leucine to demonstrate
           community has given much at-                                                                                                                                            reduced proteolysis and net protein
           tention to this important molecule,                                                                                                                                     catabolism with carnitine treat-
           but as yet there is no consensus on                                                                                                                                     ment. This is the first study to
           whether carnitine treatment im-                                                                                                                                         demonstrate these effects in HD
           proves outcomes in hemodialysis                                                                                                                                         patients and may explain in part the
           (HD) patients. Early work done in                                                                                                                                       nutritional improvements observed
           the 1980s tested a variety of hy-                                                                                                                                       by Savica et al.
           potheses and various studies have                                                                                                                                         Finally, two recently published
           examined the effect of carnitine                                                                                                                                        studies using data from the Centers
           in HD patients. While some stud-                                                                                                                                        for Medicare and Medicaid Ser-
           ies, such as those conducted by                                                                                                                                         vices (CMS) and the Fresenius

                                                                                                                                        © JIM DOWDALLS / PHOTO RESEARCHERS, INC.
           Labonia et al (Am J Kidney Dis.                                                                                                                                         Medical Care North America data-
           1995;26:757-764) and Kletzmayr                                                                                                                                          base to show carnitine treatment
           et al (Kidney Int. Suppl. 1999;69:                                                                                                                                      reduces hospitalizations. In 2005,
           S93-106), clearly showed clinical                                                                                                                                       Kazmi et al (Am J Nephrol. 2005;
           benefits, some studies were not as                                                                                                                                      25:106-115) found that a mean per-
           clear, such as a study conducted by                                                                                                                                     treatment dose of 1.5 g for an aver-
           Sloan et al (Am J Kidney Dis. 1998;                                                                                                                                     age of 9.7 months was associated
           32:265-272). Recently published                                                                                                                                         with a significant reduction in hos-
           work provides provocative data sug-      In type 2 diabetes, glucose build up in the cell (shown above) is not moderated by                                             pital stays. These results 
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