Carnitine metabolism in uremia
Carnitine metabolism in uremia
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DOI：
10.1053/ajkd.2001.27408
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发表时间：
2001-10-01
影响因子：
13.2
通讯作者：
Biolo, G
中科院分区：
文献类型：
--
作者：
Guarnieri, G;Situlin, R;Biolo, G
肉毒碱是一种条件必需代谢产物，通过参与酯交换反应和防止有机酸积累在细胞生理中起着关键作用。许多疾病状态的特征在于肉毒碱耗尽，可能导致代谢和临床紊乱。在维持性血液透析中，肉毒碱通过透析膜丢失，导致选定患者的肉毒碱耗尽，酯化形式相对增加。在透析后或透析期间补充肉毒碱可以抵消这种变化，并可能与一些临床益处有关。最近的文献荟萃分析表明，在血液透析患者中补充肉毒碱可能会改善血液学状态（允许减少对红细胞生成素的需求），运动耐量，血脂谱和透析中症状。此外，补充肉毒碱可以改善心脏功能，蛋白质代谢和胰岛素抵抗。肉毒碱补充剂最近已被美国食品和药物管理局批准，不仅用于治疗，而且用于预防透析患者的肉毒碱消耗。此外，由美国和欧洲肾病学会制定的临床指南表明，可以推荐在选定的透析患者中进行补充肉毒碱的试验，这些患者对某些条件的标准治疗没有充分反应，例如透析期间严重和持续的肌肉痉挛或低血压，缺乏能量影响生活质量，骨骼肌无力或肌病，心肌病，以及对促红细胞生成素无反应或需要大剂量促红细胞生成素的尿毒症贫血。(C)2001年由国家肾脏基金会，公司。
Carnitine is a conditionally essential metabolite that plays a critical role in cell physiology by participating in transesterification reactions and preventing organic acid accumulation. A number of disease states are characterized by carnitine depletion that may lead to metabolic and clinical disturbances. In maintenance hemodialysis, carnitine is lost through dialytic membranes, leading in selected patients to carnitine depletion with a relative increase of the esterified forms. Carnitine supplementation after or during dialysis counteracts such alterations and may be associated with some clinical benefits. Recent meta-analyses of the literature indicate that carnitine supplementation in hemodialysis patients may improve the hematological status (allowing a reduction of the requirement for erythropoletin), the exercise tolerance, the plasma lipid profile, and the intradialytic symptoms. In addition, carnitine supplementation may improve cardiac functions, protein metabolism, and insulin resistance. Carnitine supplementation has been recently approved by the US Food and Drug Administration not only for the treatment, but also for the prevention of carnitine depletion In dialysis patients. Furthermore, clinical guidelines developed by both American and European nephrological societies suggest that a trial with carnitine supplementation could be recommended in selected dialysis patients who do not adequately respond to standard therapy for certain conditions, such as severe and persistent muscle cramps or hypotension during dialysis, lack of energy affecting quality of life, skeletal muscle weakness or myopathy, cardiomyopathy, and anemia of uremia unresponsive to or requiring large doses of erythropoietin. (C) 2001 by the National Kidney Foundation, Inc.