title: L-Carnitine improves gastrointestinal disorders and altered the intestinal microbiota in hemodialysis patients.
abstract: Patients receiving hemodialysis also manifest gastrointestinal symptoms, such as constipation, caused by restriction of water intake and the loss of body water balance. Because dietary carnitine deficiency is considered to cause smooth muscle dysmotility of the gastrointestinal tract similarly to that in skeletal muscles, carnitine deficiency in hemodialysis patients may be one cause of gastrointestinal discomfort and dysfunctions. We performed a multicenter nonrandomized single-arm prospective clinical trial. Fifteen Japanese patients receiving hemodialysis were administered L-carnitine tablets (900 mg) for 3 months, and clinical and biochemical analyses were performed before and after treatment. The serum total carnitine level was increased significantly by supplementation with L-carnitine for 3 months (from 40.9 ± 2.6 μmol/l to 172.3 ± 19.0 μmol/l, p<0.05). The myasthenia score was decreased significantly by the supplementation (from 1.3 ± 0.3 to 0.8 ± 0.2, p<0.05). The frequency of passing stool tended to increase with the treatment for 3 months (from 4.2 ± 0.5 times/week to 4.8 ± 0.5 times/week). A phyla-level analysis of the microbiota showed that the composition of the individual microbiota was not different between before and after supplementation. A genus-level analysis, however, revealed that the relative abundance of genusClostridiumsubcluster 4 was significantly decreased by the supplementation (from 7.7 ± 1.9% to 4.7 ± 1.3%, p<0.05). Oral supplementation of L-carnitine to the patients receiving hemodialysis improved not only their muscle discomfort but also their gastrointestinal disorders and microbiota, although its effect on the prognosis of hemodialysis patients should be further investigated.
authors.affiliation: Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Irie
authors.affiliation: Department of Nephrology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo 160-0023, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kanno
authors.affiliation: Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Kikuchi
authors.affiliation: Apheresis and Dialysis Center, School of Medicine, Keio University, Tokyo 160-8582, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Iidabashi Murai Clinic, Tokyo 162-0822, Japan.
authors.forename: Seizo
authors.initials: S
authors.lastname: Murai
authors.affiliation: Tokyo Midtown Medical Center, Tokyo 107-6206, Japan.
authors.forename: Miwako
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Apheresis and Dialysis Center, School of Medicine, Keio University, Tokyo 160-8582, Japan.
authors.forename: Matsuhiko
authors.initials: M
authors.lastname: Hayashi
keywords: Clostridium; carnitine; constipation; microbiota