PDF herunterladen
Exp Clin Endocrinol Diabetes 2010; 118(10): 735-740
DOI: 10.1055/s-0030-1261912
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

L-Carnitine Supplementation and Adipokines in Patients with End-Stage Renal Disease on Regular Hemodialysis

B. Csiky1 , 2 , Z. Nyul3 , G. Tóth3 , I. Wittmann2 , B. Melegh4 , M. Rauh5 , W. Rascher5 , E. Sulyok6
  • 1FMC Dialysis Center Pécs, Faculty of Medicine, University of Pécs, Pécs, Hungary
  • 2Nephrological Center and 2nd Department of Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
  • 3Department of Pediatrics, Faculty of Medicine, University of Pécs, Pécs, Hungary
  • 4Department of Medical Genetics and Child Development, Faculty of Medicine, University of Pécs, Pécs, Hungary
  • 5Klinik für Kinder und Jugendliche, University of Erlangen-Nürnberg, Nürnberg, Germany
  • 6Institute of Public Health and Health Promotion and Family Care, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
Weitere Informationen

Publikationsverlauf

received 23.11.2009 first decision 10.03.2010

accepted 31.05.2010

Publikationsdatum:
23. Juli 2010 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Chronic hemodialysis (HD) patients frequently encounter carnitine depletion, elevated adipose tissue-derived hormones/cytokines, that may contribute to accelerated arteriosclerosis. 10 non-diabetic HD patients were studied over 28 weeks. In the 12 weeks treatment period 1 g l-carnitine was given iv after each HD session. Measurements of plasma free- and acylcarnitines, insulin, leptin, adiponectin, resistin and ghrelin were performed at baseline, at weeks 2, 4, 8, 12 (treatment period) and at weeks 24–28 (post-treatment period). L-carnitine supplementation resulted in progressive increase of free- and acylcarnitine levels. Plasma levels of insulin, resistin, leptin and ghrelin remained at the already elevated baseline values. L-carnitine therapy induced a significant increase in plasma adiponectin from 20.2±12.7 μg/ml (baseline) to 32.7±20.2 μg/ml in week 2 (p<0.05) and 35.4±19.6 μg/ml in week 12 (p<0.03), which remained unchanged in the post-carnitine period. Plasma insulin levels correlated positively with leptin (r=0.525, p<0.0001) and resistin (r=0.284, p<0.005); adiponectin levels correlated inversely with leptin (r=−0.255, p<0.02) and resistin (r=−0.213, p<0.04) irrespective of carnitine status. Plasma levels of adipokines and related hormones are greatly elevated in patients on regular HD. L-carnitine administration further augmented the plasma levels of protective adiponectin, therefore it may have a role in preventing cardiovascular complications of uremia.

Key words

adipokines - carnitine - end-stage renal disease - hemodialysis

References

  • 1 Antuna-Puente B, Feve B, Fellahi S. et al . Adipokines: the missing link between insulin resistance and obesity.  Diabetes Metabolism. 2008;  34 2-11
    Suche in Google Scholar
  • 2 Axelsson J, Bergsten A, Qureshi AR. et al . Elevated resistin levels in chronic kidney disease are associated with decreased glomerular filtration rate and inflammation, but not with insulin resistance.  Kidney Int. 2006;  69 596-604
    Suche in Google Scholar
  • 3 Axelsson J, Stenvinkel P. Role of fat mass and adipokines in chronic kidney disease.  Curr Opin Nephrol Hypertens. 2008;  17 25-31
    Suche in Google Scholar
  • 4 Beddhu S, Kimmel PL, Ramkumar N. et al . Associations of metabolic syndrome with inflammation in CKD: results from the Third National Health and Nutrition Examination Survey (NHANES III).  Am J Kidney Dis. 2005;  46 577-586
    Suche in Google Scholar
  • 5 Belay B, Esteban-Cruciani N, Walsh CA. et al . The use of levo-carnitine in children with renal disease: a review and a call for future studies.  Pediatr Nephrol. 2006;  21 308-317
    Suche in Google Scholar
  • 6 Bellinghieri G, Santoro D, Calvani M. et al . Carnitine and hemodialysis.  Am J Kidney Dis. 2003;  41 (Suppl. 1) S116-S122
    Suche in Google Scholar
  • 7 Calò La, Pagnine E, Davis PA. et al . Antioxidant effect of l-carnitine and its short chain esters. Revelance for the protection from oxidative stress related cardiovascular damage.  Int J Cardiol. 2006;  107 54-60
    Suche in Google Scholar
  • 8 Capaldo B, Napoli R, DiBonito P. et al . Carnitine improves peripheral glucose disposal in non-insulin-dependent diabetic patients.  Diabetes Res Clin Pract. 1991;  14 191-195
    Suche in Google Scholar
  • 9 Costacou T, Orchard TJ. Adiponectin: good, bad, or just plain ugly?.  Kidney Int. 2008;  74 549-551
    Suche in Google Scholar
  • 10 Daschner M, Tonshoff B, Blum WF. et al . Inappropriate elevation of serum leptin levels in children with chronic renal failure.  J Am Soc Nephrol. 1998;  9 1074-1079
    Suche in Google Scholar
  • 11 Duranay M, Akay H, Yilmaz FM. et al . Effects of l-carnitine infusions on inflammatory and nutritional markers in haemodialysis patients.  Nephrol Dial Transplant. 2006;  21 3211-3214
    Suche in Google Scholar
  • 12 Eknoyan G, Latos DL, Lindberg J. Practice recommendations for the use of l-carnitine in dialysis-related carnitine disorder. National Kidney Foundation Carnitine Consensus Conference.  Am J Kidney Dis. 2003;  41 868-876
    Suche in Google Scholar
  • 13 Ellis BA, Poynten A, Lowy AJ. et al . Long-chain acyl-CoA esters as indicators of lipid metabolism and insulin sensitivity in rat and human muscle.  Am J Physiol Endocrinol Metab. 2000;  279 E554-E560
    Suche in Google Scholar
  • 14 Evans A. Dialysis-related carnitine disorder and levocarnitine pharmacology.  Am J Kidney Dis. 2003;  41 (Suppl. 4) S13-S26
    Suche in Google Scholar
  • 15 Gunal AI, Celiker H, Donder E. et al . The effect of l-carnitine on insulin resistance in hemodialysed patients with chronic renal failure.  J Nephrol. 1999;  12 38-40
    Suche in Google Scholar
  • 16 Hoppel C. The role of carnitine in normal and altered fatty acid metabolism.  Am J Kidney Dis. 2003;  41 (Suppl. 4) S4-S12
    Suche in Google Scholar
  • 17 Hurot J-M, Cucherate M, Haugh M. et al . Effects of l-cartinine supplementation in maintenance hemodialysis patients: A systematic review.  J Am Soc Nephrol. 2002;  13 708-714
    Suche in Google Scholar
  • 18 Iglesias P, Diez JJ, Fernandez-Reyes MJ. et al . Serum ghrelin concentrations in patients with chronic renal failure undergoing dialysis.  Clin Endocrinol. 2006;  64 68-73
    Suche in Google Scholar
  • 19 Jorsal A, Tarnow L, Frystyk J. et al . Serum adiponectin predicts all-cause mortality and end stage renal disease in patients with type I diabetes and diabetic nephropathy.  Kidney Int. 2008;  74 649-654
    Suche in Google Scholar
  • 20 Kalantar-Zadeh K, Block G, McAlister CJ. et al . Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients.  Am J Clin Nutr. 2004;  80 299-307
    Suche in Google Scholar
  • 21 Kalantar-Zadeh K, Kopple JD. Obesity paradox in patients on maintenance dialysis.  Contrib Nephrol. 2006;  151 57-69
    Suche in Google Scholar
  • 22 Karakitsos D, De Groot E, Patrianakos AP. et al . Adiponectin and cardiovascular remodeling in end-stage renal disease and co-morbid diabetes mellitus.  Am J Nephrol. 2006;  26 340-347
    Suche in Google Scholar
  • 23 Nüsken K-D, Kratzsch J, Wienholz V. et al . Circulating resistin concentrations in children depend on renal function.  Nephrol Dial Transplant. 2006;  21 107-112
    Suche in Google Scholar
  • 24 Pecoits-Filho R, Lindholm B, Stenvinkel P. End-stage renal disease: a state of chronic inflammation and hyperleptinemia.  Eur J Clin Invest. 2003;  33 527-528
    Suche in Google Scholar
  • 25 Rajala MW, Obici S, Scherer PE. et al . Adipose-derived resistin and gut-derived resistin-like molecule-beta selectively impair insulin action on glucose production.  J Clin Invest. 2003;  111 225-230
    Suche in Google Scholar
  • 26 Shen YY, Charlesworth JA, Kelly JJ. et al . Up-regulation of adiponectin, its isoforms and receptors in end-stage kidney disease.  Nephrol Dial Transplant. 2007;  22 171-178
    Suche in Google Scholar
  • 27 Schreiber B. Levocarnitine and dialysis: A review.  Nutr Clin Pract. 2005;  20 218-243
    Suche in Google Scholar
  • 28 Scholze A, Rattensperger D, Zidek W. et al . Low serum leptin concentration predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy.  Obesity. 2007;  15 1617-1622
    Suche in Google Scholar
  • 29 Talián GL, Komlósi K, Decsi T. et al . Determination of carnitine ester patterns during the second half of pregnancy, at delivery, and in neonatal cord blood by tandem mass spectrometry: complex and dynamic involvement of carnitine in the intermediary metabolism.  Pediatr Res. 2007;  62 88-92
    Suche in Google Scholar
  • 30 Van Gaal LF, Mertens IL, De Block CE. Mechanism linking obesity with cardiovascular disease.  Nature. 2006;  444 875-880
    Suche in Google Scholar
  • 31 Vernez L, Dickenmann M, Steiger J. et al . Effect of L-carnitine on the kinetics of carnitine, acylcarnitines and butyrobetaine in long-term haemodialysis.  Nephrol Dial Transplant. 2006;  21 450-458
    Suche in Google Scholar
  • 32 Yamauchi T, Kamon J, Minokoshi Y. et al . Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activating protein kinase.  Nat Med. 2002;  8 1288-1295
    Suche in Google Scholar

Correspondence

B. CsikyMD, PhD 

FMC Dialysis Center Pécs

2nd Department of Medicine

and Nephrological Center

Faculty of Medicine

University of Pécs

Pacsirta u. l. H-7624 Pécs

Hungary

Telefon: +36/72/536 067

Fax: +36/72/536 070

eMail: botond.csiky@gmail.com