title: L-Carnitine status in end-stage renal disease patients on automated peritoneal dialysis.
abstract: BACKGROUND
  Carnitine metabolism in patients on peritoneal dialysis (PD), particularly automated PD (APD), has not been extensively evaluated. Here, we examined levels of a large number of carnitine species in plasma from adult uremic patients treated with continuous ambulatory PD (CAPD) or APD, vetting whether L-carnitine may be used in the solution bag for APD therapy.
  
  
  METHODS
  Plasma levels of carnitine and its esters were measured by high-performance liquid chromatography/tandem quadrupole mass spectrometry in 14 patients on CAPD (3 × 1.5 % glucose daily and icodextrin overnight), 16 patients on APD (tidal modality), and 8 age- and gender-matched healthy controls. PD groups did not differ with regard to demographic characteristics, renal function, dialysis features, peritoneal function, or biochemistry. In five APD patients, we also examined the safety and efficacy of L-carnitine (5 g) addition to one night-dwell solution bag over five consecutive days.
  
  
  RESULTS
  Several abnormalities were found in plasma carnitine species of PD patients as compared to controls, mainly represented by a reduction of free carnitine and an increase in acetyl-carnitine, dicarboxylic and other carnitines. The main carnitine species (free carnitine, acetyl-carnitine) were significantly lower in plasma from APD than CAPD patients. APD patients tolerated L-carnitine supplementation well, laboratory, physical and dialysis parameters proving stable.
  
  
  CONCLUSIONS
  Plasma carnitine metabolism is abnormal in patients on PD, and may be influenced by the PD modality. Given the good tolerability and potential advantages of carnitine used in the PD fluid, L-carnitine-containing solution bags in APD treatment definitely merit further evaluation.
authors.affiliation: Department of Medicine, Institute of Nephrology, "SS. Annunziata" Hospital, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini, 66013, Chieti, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Liberato
authors.affiliation: Department of Research and Development, CoreQuest Sagl, Tecnopolo, Bioggio, Switzerland.
authors.forename: Arduino
authors.initials: A
authors.lastname: Arduini
authors.affiliation: Department of Experimental and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rossi
authors.affiliation: Unit of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Di Castelnuovo
authors.affiliation: Department of Medicine, Institute of Nephrology, "SS. Annunziata" Hospital, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini, 66013, Chieti, Italy.
authors.forename: Cosima
authors.initials: C
authors.lastname: Posari
authors.affiliation: Department of Experimental and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sacchetta
authors.affiliation: Department of Internal Medicine, University Tor Vergata, Rome, Italy.|IRCCS-Santa Lucia Foundation, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Urbani
authors.affiliation: Department of Medicine, Institute of Nephrology, "SS. Annunziata" Hospital, G. d'Annunzio University of Chieti-Pescara, Via dei Vestini, 66013, Chieti, Italy. m.bonomini@nephro.unich.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Bonomini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D015415:Biomarkers / Q000097:blood; D002331:Carnitine / Q000097:blood* / Q000627:therapeutic use; D016022:Case-Control Studies; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D011446:Prospective Studies; D053719:Tandem Mass Spectrometry; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D002331:Carnitine
keywords: APD; CAPD; Carnitine species; End-stage renal disease; L-carnitine