Carnitine metabolism in renal disease and dialysis
- Alan Wasserstein, MD
Alan Wasserstein, MD
- Associate Professor of Medicine
- University of Pennsylvania School of Medicine
Carnitine deficiency may be a significant problem in patients with kidney disease, particularly in those undergoing maintenance dialysis. A discussion of carnitine metabolism, as well as the role of carnitine supplementation in this patient population, is presented in this topic review.
ROLE OF CARNITINE IN INTERMEDIARY METABOLISM
Carnitine is an important intermediary in fat metabolism. It is required to shuttle long-chain fatty acids, in the form of acylcarnitines, into mitochondria for beta-oxidation; carnitine is, therefore, crucial for energy production in tissues dependent upon fatty acid oxidation, such as cardiac and skeletal muscle.
Reactions of carnitine with activated fatty acids (acyl CoA) are esterifications of the general form:
acyl CoA + carnitine -> acylcarnitine + CoASH
and are catalyzed by a family of carnitine acyltransferases.
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- ROLE OF CARNITINE IN INTERMEDIARY METABOLISM
- RENAL HANDLING AND METABOLISM OF CARNITINE IN RENAL FAILURE
- Alterations in chronic kidney dysfunction
- Metabolism in hemodialysis
- Metabolism in peritoneal dialysis
- Carnitine deficiency and dialysis patients
- CLINICAL FEATURES OF CARNITINE DEFICIENCY
- CARNITINE SUPPLEMENTATION IN DIALYSIS PATIENTS
- Protein and muscle catabolism and signs of inflammation
- Lipid metabolism
- Exercise limitation and oxygen consumption
- Intradialytic complications
- Quality of life
- Anemia and response to erythropoietin
- Cardiovascular effects
- CONSENSUS STATEMENTS AND GUIDELINES
- L-carnitine dose and route of administration
- SUMMARY AND RECOMMENDATIONS