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Nutrition1009.qxd 9/25/09 4:42 PM Page 1 42 Renal & Urology News OCTOBER 2009 www.renalandurologynews.com 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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