scholarly journals Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Peritoneal Dialysis

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2645 ◽  
Author(s):  
Satoshi Shimizu ◽  
Hiroyuki Takashima ◽  
Ritsukou Tei ◽  
Tetsuya Furukawa ◽  
Makiyo Okamura ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Serum Concentrations ◽  
Clinical Factors ◽  
Carnitine Level ◽  
Serum Free ◽  
Factors Associated ◽  
Carnitine Concentration

Background: Carnitine deficiency is common in patients on dialysis. Serum free carnitine concentration is significantly lower in patients on hemodialysis (HD) than in healthy individuals. However, there are few reports on serum free carnitine concentration in patients on peritoneal dialysis (PD). Methods: We examined serum concentrations of total, free, and acylcarnitine and the acylcarnitine/free carnitine ratio in 34 PD and 34 age-, sex-, and dialysis duration-matched HD patients. We investigated the prevalence of carnitine deficiency and clinical factors associated with carnitine deficiency in the PD group. Results: Prevalence of carnitine deficiency was 8.8% in the PD group and 17.7% in the HD group (p = 0.283). High risk of carnitine deficiency was found in 73.5% of the PD group and 76.4% of the HD group (p = 0.604). Carnitine insufficiency was found in 82.3% of the PD group and 88.2% of HD group (p = 0.733). Multivariate analysis revealed that duration of dialysis and age were independent predictors of serum free carnitine level in the PD group. Conclusions: The prevalence of carnitine deficiency, high risk of carnitine deficiency, and carnitine insufficiency in PD patients was 8.8%, 73.5%, and 82.3%, respectively. These rates were comparable to those in patients on HD.

scholarly journals Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Peritoneal Dialysis

2019 ◽  
Author(s):  
Satoshi Shimizu ◽  
Hiroyuki Takashima ◽  
Ritsukou Tei ◽  
Tetsuya Furukawa ◽  
Makiyo Okamura ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Serum Concentrations ◽  
Clinical Factors ◽  
Carnitine Level ◽  
Serum Free ◽  
Factors Associated ◽  
Carnitine Concentration

Background: Carnitine deficiency is common in patients on dialysis. Serum free carnitine concentration is significantly lower in patients on hemodialysis (HD) than in healthy individuals. However, there are few reports on serum free carnitine concentration in patients on peritoneal dialysis (PD). Methods: We examined serum concentrations of total, free, and acylcarnitine and the acylcarnitine/free carnitine ratio in 34 PD and 34 age-, sex-, and dialysis duration-matched HD patients. We investigated the prevalence of carnitine deficiency and clinical factors associated with carnitine deficiency in the PD group. Results: Prevalence of carnitine deficiency was 8.8% in the PD group and 14.7% in the HD group (P = 0.45). High risk of carnitine deficiency was found in 79.4% of the PD group and 85.3% of the HD group (P = 0.52). Carnitine insufficiency was found in 82.3% of the PD group and 88.2% of HD group (P = 0.49). Multivariate analysis revealed that duration of dialysis and age were independent predictors of serum free carnitine level in the PD group. Conclusions: The prevalence of carnitine deficiency, high risk of carnitine deficiency, and carnitine insufficiency in PD patients was 8.8%, 79.4%, and 82.3%, respectively. These rates were comparable to those in patients on HD.

Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Hemodialysis

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 38-44 ◽  
Author(s):  
Yoshinari Hatanaka ◽  
Terumi Higuchi ◽  
Yurie Akiya ◽  
Tomomi Horikami ◽  
Ritsukou Tei ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Multivariate Regression ◽  
Reduction Rate ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Prevalence Rates ◽  
Carnitine Level ◽  
Serum Free ◽  
Free Serum

Background: Patients on hemodialysis (HD) are known to be at risk of carnitine deficiency. The aims of this study were to investigate the prevalence of carnitine deficiency in patients on dialysis and to compare the likelihood of a reduction in the serum carnitine level on HD with that on hemodiafiltration (HDF). Methods: The prevalence of carnitine deficiency, defined as a serum free carnitine level < 20 μmol/L, and that of carnitine insufficiency, defined as an acyl/free carnitine ratio > 0.4, was investigated in 150 patients on dialysis. The reduction rate of serum carnitine was then compared between HD and HDF. Results: The prevalence of carnitine deficiency and that of carnitine insufficiency was 25.3 and 86.7%, respectively. Patients at high risk of carnitine deficiency accounted for 64.7%. Multivariate regression identified an association of duration of dialysis with the free serum carnitine level. The reduction rates of serum free carnitine in HD and HDF were 64 ± 4 and 75 ± 7%, respectively (p < 0.0001). Conclusion: The prevalence rates of carnitine deficiency and carnitine insufficiency were high in patients on dialysis. The serum carnitine reduction rate was greater with HDF than with HD.

Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 235-238
Author(s):  
S. Ramalakshmi ◽  
Bjoe Baben ◽  
Ben S. Ashok ◽  
V. Jayanthi ◽  
Nancy Leslie ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Dialysis Patients ◽  
Carnitine Level ◽  
Daily Urine ◽  
The Mean ◽  
Daily Urine Output

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.

Carnitine Deficiency in Epilepsy: Risk Factors and Treatment

1995 ◽  
Vol 10 (2_suppl) ◽  
pp. 2S32-2S39 ◽  
Author(s):  
David L. Coulter
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Preliminary Data ◽  
Metabolic Diseases ◽  
Drug Effects ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Specific Drug ◽  
Asymptomatic Patients ◽  
The Relationship

Numerous studies have shown that plasma carnitine levels are significantly lower in patients taking valproate than in controls. Free carnitine deficiency is not uncommon in these patients and also occurs in newborns with seizures and in patients taking other anticonvulsant drugs. Carnitine deficiency in epilepsy results from a variety of etiologic factors including underlying metabolic diseases, nutritional inadequacy, and specific drug effects. The relationship between carnitine deficiency and valproate-induced hepatotoxicity is unclear. Carnitine treatment does not always prevent the emergence of serious hepatotoxicity, but it does alleviate valproate-induced hyperammonemia. These studies suggest that specific risk factors for carnitine deficiency can be identified. Preliminary data suggest that carnitine treatment may benefit high-risk, symptomatic patients and those with free carnitine deficiency. Carnitine treatment is not likely to benefit low-risk, asymptomatic patients and those with normal carnitine levels. (J Child Neurol 1995;10(Suppl):2S32-2S39).

scholarly journals Effects of l-Carnitine Supplementation in Patients Receiving Hemodialysis or Peritoneal Dialysis

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3371 ◽  
Author(s):  
Masako Kuwasawa-Iwasaki ◽  
Hiroaki Io ◽  
Masahiro Muto ◽  
Saki Ichikawa ◽  
Keiichi Wakabayashi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Function ◽  
Acid Metabolism ◽  
Carnitine Deficiency ◽  
Muscle Spasm ◽  
Free Carnitine ◽  
Carnitine Supplementation ◽  
Dialysis Patients ◽  
Muscle Spasms ◽  
Total Carnitine

l-carnitine is an important factor in fatty acid metabolism, and carnitine deficiency is common in dialysis patients. This study evaluated whether l-carnitine supplementation improved muscle spasm, cardiac function, and renal anemia in dialysis patients. Eighty Japanese outpatients (62 hemodialysis (HD) patients and 18 peritoneal dialysis (PD) patients) received oral l-carnitine (600 mg/day) for 12 months; the HD patients further received intravenous l-carnitine injections (1000 mg three times/week) for 12 months, amounting to 24 months of treatment. Muscle spasm incidence was assessed using a questionnaire, and cardiac function was assessed using echocardiography. Baseline free carnitine concentrations were relatively low in patients who underwent dialysis for >4 years. Total carnitine serum concentration, free carnitine, and acylcarnitine significantly increased after oral l-carnitine treatment for 12 months, and after intravenous l-carnitine injection. There was no significant improvement in muscle spasms, although decreased muscle cramping after l-carnitine treatment was reported by 31% of patients who had undergone HD for >4 years. Hemoglobin concentrations increased significantly at 12 and 24 months in the HD group. Therefore, l-carnitine may be effective for reducing muscle cramping and improving hemoglobin levels in dialysis patients, especially those who have been undergoing dialysis for >4 years.

Carnitine insufficiency in children with inborn errors of metabolism: prevalence and treatment efficacy

2015 ◽  
Vol 28 (11-12) ◽  
Author(s):  
Ilgar Mamedov ◽  
Irina Zolkina ◽  
Ekaterina Nikolaeva ◽  
Pavel Glagovsky ◽  
Vladimir Sukhorukov
Keyword(s):  
Fatty Acids ◽  
Plasma Level ◽  
Psychomotor Retardation ◽  
Carnitine Deficiency ◽  
Free Carnitine ◽  
Hereditary Diseases ◽  
Inborn Errors ◽  
Carnitine Level ◽  
Subsequent Investigation ◽  
Systemic Carnitine Deficiency

AbstractCarnitine is necessary for the transfer of long-chain fatty acids from the cytosol into mitochondria for subsequent β-oxidation. A carnitine deficiency results in impaired energy production from fatty acids.We reviewed the plasma level of total carnitine, free carnitine, and acylcarnitines in 1270 children with psychomotor retardation, low growth, and weight parameters. Tandem mass spectrometry (MS/MS) was applied. Low free carnitine level in plasma was used as a marker of carnitine deficiency.A total of 102 (8%) children had free carnitine level <19 μmol/L (norm 19–60 μmol/L). As a result of the subsequent investigation, hereditary diseases were diagnosed in 76 (¾) children and out of that 19 had very low free carnitine plasma level (<10 μmol/L). Fanconi syndrome, fat oxidation defects, primary systemic carnitine deficiency, mitochondrial encephalomyopathy, and Noonan syndrome were revealed in these 19 children.Efficacy of levocarnitine treatment in children with very low free carnitine level differs according to pathogenesis of diseases. The highest efficacy was observed in primary systemic carnitine deficiency.

Predictors of thromboprophylaxis in hospitalised medical patients

2015 ◽  
Vol 113 (05) ◽  
pp. 1127-1134 ◽  
Author(s):  
David Spirk ◽  
Mathieu Nendaz ◽  
Drahomir Aujesky ◽  
Daniel Hayoz ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Score ◽  
Low Risk ◽  
Medical Patients ◽  
Clinical Factors ◽  
Thromboembolic Risk ◽  
Factors Associated ◽  
Risk Patients

summaryBoth, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials. gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75–8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69–4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31–4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among highrisk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

scholarly journals Trends for and Clinical Factors Associated with Choice of Oral P2Y12 Inhibitors for Patients on Chronic Dialysis

2019 ◽  
Vol 33 (5) ◽  
pp. 511-521 ◽  
Author(s):  
Nishank Jain ◽  
Suzanne L. Hunt ◽  
Huizhong Cui ◽  
Milind A. Phadnis ◽  
Jonathan D. Mahnken ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Esrd Patient ◽  
Chronic Dialysis ◽  
Clinical Factors ◽  
Related Factors ◽  
P2y12 Inhibitors ◽  
Factors Associated ◽  
Prescribing Trends ◽  
To Receive ◽  
Esrd Patients

ABSTRACT Background Trends and clinical factors associated with prescribing choices for oral P2Y12 inhibitors (P2Y12-I) remain unknown for patients on chronic dialysis, i.e., with end-stage renal disease (ESRD). Methods From 2011–2014 U.S. Renal Data System registry, we identified 36,542 ESRD patients who received new prescriptions for P2Y12-I (median age 64.0 years and 54% males). Of the cohort, 93% were receiving hemodialysis and 7% on peritoneal dialysis. We analyzed trends and investigated clinical factors associated with specific P2Y12-I prescribed. Results Clopidogrel was prescribed for 95%, prasugrel for 3%, and ticagrelor for 2%. Clopidogrel was favored for those ≥75 years (18% of cohort). Compared to Caucasians, African Americans (36% of cohort) and Hispanics (19% of cohort) were less likely to receive prasugrel and ticagrelor (P<0.05). Patients receiving hemodialysis versus peritoneal dialysis were less likely to receive prasugrel over clopidogrel, adjusted odds ratio (aOR) 0.67 (0.55-0.82). Each additional year of dialysis decreased the odds of receiving prasugrel over clopidogrel, aOR 0.91 (0.85-0.98). History of atrial fibrillation reduced the odds of receiving ticagrelor or prasugrel over clopidogrel, aOR 0.69 (0.54-0.89) and 0.73 (0.60-0.89), respectively. Concomitant oral anticoagulant use was not associated with choice of P2Y12-I. Occurrence of non-ST segment elevation myocardial infarction or percutaneous coronary intervention within the 6-month period prior to the index date favored ticagrelor over prasugrel, aOR 1.31 (1.06-1.62) and 1.29 (1.01-1.66), respectively. However, prescribing trends favoring ticagrelor over prasugrel were not observed for deployment of drug-eluting, or multiple coronary stents. Conclusion Between 2011 and 2014, clopidogrel remained the most common P2Y12-I whereas ticagrelor and prasugrel remained underutilized in ESRD patients. Prescribing practices for these drugs were based upon clinically approved indication for their use in the general population as well as perceived complexity of an ESRD patient including demographics, dialysis-related factors and comorbidities. Comparative effectiveness studies involving ESRD patients are needed to prove that ticagrelor and prasugrel are just as safe and effective as clopidogrel before clinicians can make informed decisions for choice of P2Y12-I in this patient population.

scholarly journals Clinical Factors Associated with Sodium Removal in Peritoneal Dialysis Patients

2011 ◽  
Vol 39 (5) ◽  
pp. 1883-1889 ◽  
Author(s):  
YS Shan ◽  
XQ Ding ◽  
J Ji ◽  
WL Lv ◽  
XS Cao ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Factors ◽  
Dialysis Patients ◽  
Factors Associated ◽  
Sodium Removal
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