American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 803-812 , November 2007

Protective Effect of Intravenous Levocarnitine on Subsequent-Month Hospitalization Among Prevalent Hemodialysis Patients, 1998 to 2003

  • Eric D. Weinhandl, MS

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • Corresponding Author InformationAddress correspondence to Eric D. Weinhandl, MS, Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 S 8th St, Ste S-253, Minneapolis, MN 55404.
    • ,
  • Madhumati Rao, MD

      Affiliations

    • Tufts–New England Medical Center, Boston, MA
    • ,
  • David T. Gilbertson, PhD

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • ,
  • Allan J. Collins, MD

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • University of Minnesota, Minneapolis, MN.
    • ,
  • Brian J.G. Pereira, MD

      Affiliations

    • Tufts–New England Medical Center, Boston, MA

Received 2 February 2007 ,Accepted 12 July 2007.

References 

  1. Hoppel C. The role of carnitine in normal and altered fatty acid metabolism. Am J Kidney Dis. 2003;41(suppl 4):S4–S12
  2. Hedayati SS. Dialysis-related carnitine disorder. Semin Dial. 2006;19:323–328
  3. Evans AM, Faull R, Fornasini G, et al. Pharmacokinetics of l-carnitine in patients with end-stage renal disease undergoing long-term hemodialysis. Clin Pharmacol Ther. 2000;68:238–249
  4. Evans AM, Faull RJ, Nation RL, et al. Impact of hemodialysis on endogenous plasma and muscle carnitine levels in patients with end-stage renal disease. Kidney Int. 2004;66:1527–1534
  5. Fornasini GF, Evans A. Analysis of l-carnitine in plasma of ESRD patients undergoing chronic dialysis: What is the best assay?. Dial Transplant. 2003;32(suppl 1):S1–S12
  6. Bellinghieri G, Savica V, Mallamace A, et al. Correlation between increased serum and tissue l-carnitine levels and improved muscle symptoms in hemodialyzed patients. Am J Clin Nutr. 1983;38:523–531
  7. Savica V, Bellinghieri G, Di Stefano C, et al. Plasma and muscle carnitine levels in haemodialysis patients with morphological-ultrastructural examination of muscle samples. Nephron. 1983;35:232–236
  8. Ahmad S, Robertson HT, Golper TA, et al. Multicenter trial of l-carnitine in maintenance hemodialysis patients (II. Clinical and biochemical effects). Kidney Int. 1990;38:912–918
  9. Semeniuk J, Shalansky KF, Taylor N, et al. Evaluation of the effect of intravenous l-carnitine on quality of life in chronic hemodialysis patients. Clin Nephrol. 2000;54:470–477
  10. van Es A, Henny FC, Kooistra MP, et al. Amelioration of cardiac function by l-carnitine administration in patients on hemodialysis. Contrib Nephrol. 1992;98:28–35
  11. Labonia WD. l-Carnitine effects on anemia in hemodialyzed patients treated with erythropoietin. Am J Kidney Dis. 1995;26:757–764
  12. Matsumoto Y, Amano I, Hirose S, et al. Effects of l-carnitine supplementation on renal anemia in poor responders to erythropoietin. Blood Purif. 2001;19:24–32
  13. Kadiroglu AK, Yilmaz ME, Sit D, et al. The evaluation of postdialysis l-carnitine administration and its effect on weekly requiring doses of rHuEPO in hemodialysis patients. Ren Fail. 2005;27:367–372
  14. Caruso U, Leone L, Cravotto E, et al. Effects of l-carnitine on anemia in aged hemodialysis patients treated with recombinant human erythropoietin: A pilot study. Dial Transplant. 1998;27:498–506
  15. Kazmi WH, Obrador GT, Sternberg M, et al. Carnitine therapy is associated with decreased hospital utilization among hemodialysis patients. Am J Nephrol. 2005;25:106–115
  16. Steinman TI, Nissenson AR, Glassock RJ, et al. l-Carnitine use in dialysis patients: Is national coverage for supplementation justified? (What were CMS regulators thinking—or were they?). Nephrol News Issues. 2003;17:28–3032-34, 36 passim
  17. US Renal Data System. USRDS 2004 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2004;
  18. Robins JM: Marginal structural models versus structural nested models as tools for causal inference, in Halloran E, Berry D: Statistical Models in Epidemiology: The Environment and Clinical Trials. New York, NY, Springer-Verlag, 1999, 95-134
  19. Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11:550–560
  20. Schreiber B. Levocarnitine and dialysis: A review. Nutr Clin Pract. 2005;20:218–243
  21. Kalantar-Zadeh K, Kopple JD, Block G, et al. A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001;38:1251–1263
  22. Kalantar-Zadeh K, McAllister CJ, Lehn RS, et al. Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis. 2003;42:761–773
  23. Stenvinkel P, Heimburger O, Lindholm B, et al. Are there two types of malnutrition in chronic renal failure? (Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome)). Nephrol Dial Transplant. 2000;15:953–960
  24. 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
  25. Vazelov E, Borissova AM, Kirilov G, et al. l-Carnitine consecutively administered to patients on hemodialysis improves beta-cell response. Int J Artif Organs. 2003;26:304–307
  26. Calvani M, Benatti P, Mancinelli A, et al. Carnitine replacement in end-stage renal disease and hemodialysis. Ann N Y Acad Sci. 2004;1033:52–66
  27. Shinohara K, Shoji T, Emoto M, et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol. 2002;13:1894–1900
  28. Zoccali C, Tripepi G, Cambareri F, et al. Adipose tissue cytokines, insulin sensitivity, inflammation, and cardiovascular outcomes in end-stage renal disease patients. J Ren Nutr. 2005;15:125–130
  29. Vesela E, Racek J, Trefil L, et al. Effect of l-carnitine supplementation in hemodialysis patients. Nephron. 2001;88:218–223
  30. Bellinghieri G, Santoro D, Calvani M, et al. Role of carnitine in modulating acute-phase protein synthesis in hemodialysis patients. J Ren Nutr. 2005;15:13–17
  31. 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
  32. Hurot JM, Cucherat M, Haugh M, et al. Effects of l-carnitine supplementation in maintenance hemodialysis patients: A systematic review. J Am Soc Nephrol. 2002;13:708–714
  33. Collins AJ, Roberts TL, St Peter WL, et al. United States Renal Data System assessment of the impact of the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines. Am J Kidney Dis. 2002;39:784–795
  34. Eckardt KU. Managing a fateful alliance: Anaemia and cardiovascular outcomes. Nephrol Dial Transplant. 2005;20(suppl 6):Svi16–Svi20
  35. Rocco MV, Frankenfield DL, Hopson SD, et al. Relationship between clinical performance measures and outcomes among patients receiving long-term hemodialysis. Ann Intern Med. 2006;145:512–519
  36. Pauly DF, Pepine CJ. The role of carnitine in myocardial dysfunction. Am J Kidney Dis. 2003;41(suppl 4):S35–S43
  37. US Renal Data System. USRDS 2006 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2006;
  38. Dhingra H, Laski ME. Outcomes research in dialysis. Semin Nephrol. 2003;23:295–305
  39. Lin DY, Psaty BM, Kronmal RA. Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics. 1998;54:948–963
  40. Hebert PL, Geiss LS, Tierney EF, et al. Identifying persons with diabetes using Medicare claims data. Am J Med Qual. 1999;14:270–277
  41. Pine M, Jordan HS, Elixhauser A, et al. Enhancement of claims data to improve risk adjustment of hospital mortality. JAMA. 2007;297:71–76
  42. Steinman TI. l-Carnitine supplementation in dialysis patients: Does the evidence justify its use?. Semin Dial. 2005;18:1–2

 Because an author of this manuscript is based as Tufts-New England Medical Center, the peer-review and decision-making processes were handled entirely by an outside editor, Akinlolu Ojo, MD, PhD, University of Michigan, who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.Originally published online as doi:10.1053/j.ajkd.2007.07.017 on September 12, 2007.

PII: S0272-6386(07)01086-4

doi: 10.1053/j.ajkd.2007.07.017

American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 803-812 , November 2007

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