Background: There are many causes of carnitine depletion in hemodialysis patients; carnitine insufficiency may contribute to renal anemia. In the current study, we examined whether L-carnitine supplementation could improve renal anemia. In addition, we examined whether proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) contribute to patient response to L-carnitine supplementation.
Methods: We studied 40 hemodialysis patients; they showed decreased free carnitine levels and were selected to receive L-carnitine intravenously after each hemodialysis session for six months. Before and after treatment, we measured the level of hemoglobin, iron parameters, TNF-alpha, IFN-gamma and weekly doses of recombinant human erythropoietin (rHuEPO).
Results: There was no difference in hemoglobin level, however the doses of weekly rHuEPO were decreased significantly after L-carnitine treatment (3735.29+/-1728.76 U/week Vs 3000.02+/-1858.64 U/week, p=0.02). The serum levels of transferrin, total iron binding capacity and ferritin were significantly increased after L-carnitine treatment. Transferrin saturation, serum albumin, parathyroid hormone and C-reactive protein were not changed. In addition, TNF-alpha and IFN-gamma were not changed either.
Conclusion: A reduction in rHuEPO was achieved during L-carnitine treatment while maintaining a constant hemoglobin level, which was not related to proinflammatory cytokines; however, it may be attributed to increased serum transferrin levels.
|