Carnitine replacement in end-stage renal disease and hemodialysis
Carnitine replacement in end-stage renal disease and hemodialysis
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DOI：
10.1196/annals.1320.005
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发表时间：
2004-01-01
期刊：
影响因子：
--
通讯作者：
Brass, EP
中科院分区：
文献类型：
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作者：
Calvani, M;Benatti, P;Brass, EP
在尚未进行血液透析(HD)的慢性肾功能衰竭患者中，血浆酰化肉碱积聚的部分原因是肾脏对酯化肉碱部分的清除减少。在这些患者中，通常在血浆中发现高的酰肉碱/游离肉碱比率。维持性血液透析患者，通常表现为血浆肉碱不足，原因是代谢中间产物积累，肉碱生物合成受损，蛋白质摄入量减少，通过血液透析排出增加。血浆肉碱浓度在透析期间迅速下降到基线水平的40%，在透析间期肉碱浓度缓慢恢复，主要来自储存器官(骨骼肌)。饮食摄入量对血液透析患者的肉碱平衡也起着重要作用，因为这些患者的营养不良患病率从18%到75%不等。这可能会不同地影响身体的不同部分，导致临床后果，如肌肉功能受损、伤口愈合减少、呼吸反应改变和免疫功能异常。反复的血液透析治疗与骨骼肌中肉碱储存的减少有关。透析后静脉注射L肉碱可补充血液中游离的肉碱，有助于肌肉肉碱含量的补充。在选定的尿毒症患者中补充LC可能会通过改善几种情况而产生临床益处，如促红细胞生成素抵抗性贫血、心功能下降、透析中低血压、肌肉症状以及运动和功能能力受损。此外，LC可能通过促进蛋白质正平衡，减轻胰岛素抵抗和慢性炎症，可能通过影响瘦素抵抗，对HD患者的营养状况产生积极影响。
In patients with chronic renal failure, not yet undergoing hemodialysis (HD), plasma acylcarnitines accumulate in part due to a decreased renal clearance of esterified carnitine moieties. In these patients, a high acyl-carnitine/free-carnitine ratio is usually found in plasma. Patients undergoing maintenance HD, usually present With plasma carnitine insufficiency, due to accumulation of metabolic intermediates combined with impaired carnitine biosynthesis, reduced protein intake and increased removal via HD. Plasma carnitine concentrations rapidly decrease to 40% of baseline level during the dialysis session, with a slow restoration of the carnitine concentration during the interdialytic period, mainly from organs of storage (skeletal muscle). Dietary intake also plays an important role in carnitine homeostasis of HD patients since the prevalence of malnutrition ranges from 18% to 75% of these cases. This could differentially affect various body compartments, with clinical consequences such as impaired muscle function, decreased wound healing, altered ventilatory response, and abnormal immune function. Repeated hemodialytic treatments are associated with decreased carnitine stores in skeletal muscle. The administration of intravenous L-carnitine (LC) postdialysis replenishes the free carnitine removed from the blood and contributes to replenishment of muscle carnitine content. LC supplementation in selected uremic patients may yield clinical benefits by ameliorating several conditions, such as erythropoietin-resistant anemia, decreased cardiac performance, intradialytic hypotension, muscle symptoms, as well as impaired exercise and functional capacities. Furthermore, LC may positively influence the nutritional status of HD patients by promoting a positive protein balance, and by reducing insulin resistance and chronic inflammation, possibly through an effect on leptin resistance.