L-carnitine supplementation in the dialysis population: are Australian patients missing out?
It has been widely established that patients with end-stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L-carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin-resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L-carnitine for the treatment of erythropoietin-resistant anaemia and/or intradialytic hypotension in patients with low endogenous L-carnitine concentrations. It has been estimated that in the period of 1998-2003, 3.8-7.2% of all haemodialysis patients in the USA received at least one dose of L-carnitine, with 2.7-5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L-carnitine within Australia is virtually non-existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L-carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting.
Reuter
Stephanie E
SE
Sansom Institute, University of South Australia, and Department of Renal Medicine, Royal Adelaide Hospital, South Australia, Australia.
Faull
Randall J
RJ
Evans
Allan M
AM
D000740:Anemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D001205:Ascorbic Acid / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002331:Carnitine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D006435:Renal Dialysis; D013021:South Australia / Q000453:epidemiology; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use*; D014815:Vitamins / Q000493:pharmacokinetics* / Q000627:therapeutic use; D014904:Western Australia / Q000453:epidemiology
D014815:Vitamins; D014803:Vitamin B Complex; D001205:Ascorbic Acid; D002331:Carnitine