Carnitine and hemodialysis
Carnitine and hemodialysis
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DOI：
10.1053/ajkd.2003.50099
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发表时间：
2003-03-01
影响因子：
13.2
通讯作者：
Savica, V
中科院分区：
文献类型：
--
作者：
Bellinghieri, G;Santoro, D;Savica, V
肉碱是一种小分子物质，广泛存在于从原核生物到真核生物的所有细胞中。它是脂肪酸β-氧化过程中的重要元素。血液透析患者缺乏肉碱是由于肉碱合成不足，特别是透析膜的丢失，导致部分患者肉碱耗竭，酯化形式相对增加。作者发现，在卡尼汀治疗期间，透析患者的血浆甘油三酯降低，高密度脂蛋白胆固醇(HDLE)升高。许多研究表明，补充L肉碱可以改善尿毒症患者出现的几种并发症，包括心脏并发症、运动和功能能力受损、肌肉症状、症状性透析中低血压增加和促红细胞生成素抵抗性贫血，使降低的红细胞卡尼汀棕榈酰转移酶活性正常化。此外，补充肉碱可能改善蛋白质代谢和胰岛素抵抗。最近，肉碱补充剂已被美国食品和药物管理局批准，不仅用于治疗，还用于预防透析患者的肉碱消耗。在血液透析患者中定期补充肉碱可以改善他们的脂代谢、蛋白质营养、抗氧化状态，以及需要大剂量促红细胞生成素的贫血，还可以减少透析中肌肉痉挛、低血压、虚弱、肌肉无力和心肌病的发生率。
Carnitine, gamma-trimethyl-beta-hydroxybutyrobetaine, is a small molecule widely present in all cells from prokaryotic to eukaryotic. It is an important element in the beta-oxidation of fatty acids. A lack of carnitine in hemodialysis patients is caused by insufficient carnitine synthesis and particularly by the loss through dialytic membranes, leading in some patients to carnitine depletion with a relative increase of esterified forms. The authors found a decrease in plasma-triglyceride and increase of high-density lipoprotein cholesterol (HDL-Chol) in dialysis patients during carnitine treatment. Many studies have shown that L-carnitine supplementation leads to improvements in several complications seen in uremic patients, including cardiac complications, impaired exercise and functional capacities, muscle symptoms, increased symptomatic intradialytic hypotension, and erythropoietin-resistant anemia, normalizing the reduced carnitine palmitoyl transferase activity in red cells. In addition, carnitine supplementation may improve protein metabolism and insulin resistance. Recently, carnitine supplementation has been approved by the US Food and Drug Administration not only for the treatment, but also for the prevention of carnitine depletion in dialysis patients. Regular carnitine supplementation in hemodialysis patients can improve their lipid metabolism, protein nutrition, antioxidant status, and anemia requiring large doses of erythropoietin, It also may reduce the incidence of intradialytic muscle cramps, hypotension, asthenia, muscle weakness, and cardiomyopathy.