L-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients. Nutritional effects of carnitine supplementation in hemodialysis patients. Randomized controlled trial of nutritional counseling on body composition and dietary intake in severe CKD. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial Bicarbonate supplementation slows progression of CKD and improves nutritional status. Advanced chronic kidney disease populations have elevated trimethylamine N-oxide levels associated with increased cardiovascular events. Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation. Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation. Effects of a supplemented hypoproteic diet in chronic kidney disease.
Scattered reports indicate that L-carnitine may suppress proinflammatory cytokines in sick individuals without renal disease and may improve protein synthesis or nitrogen balance either in patients without renal disease or in maintenance hemodialysis ( MHD ) or chronic peritoneal dialysis patients . We conducted an experimental study in MHD patients to evaluate the effects of L-carnitine treatment on inflammatory and protein-energy nutritional status .  MHD patients were assigned to receive intravenous injections of L-carnitine 20 mg/kg ( n = 48 ) or placebo ( n = 65 ) thrice weekly at the end of each hemodialysis treatment for 6 months . The carnitine-treated group showed a statistically significant decrease in serum C-reactive protein and increase in serum albumin and transferrin , blood hemoglobin , and body mass index . Conversely , in the placebo-treated group , a significant decrease was reported for serum albumin , serum transferrin , and body mass index , whereas the other considered measures did not change significantly . These preliminary findings suggest that in MHD patients , L-carnitine therapy may suppress inflammation , particularly among those patients with C-reactive protein > or =3 mg/dL , and may improve protein-energy nutritional status AIMS Carnitine is involved in fatty acid metabolism and it is cleared by dialysis . As it plays a role in energy utilization and because malnutrition is a frequent complication of HD treatment , we studied the effects of carnitine supplementation on several nutritional parameters in HD patients . MATERIAL AND METHODS The main selection criterion was a body mass index ( BMI ; body weight/(height)2 ) < 22 kg/m2 . Fifty-three patients were enrolled to participate in this open and r and omized study . For 6 months , 28 patients received 15 mg/kg of intravenous L-carnitine at the end of each  hemodialysis ( HD ) treatment  ( Group A ) , the remaining 25 patients were controls ( Group B ) . The measured parameters were the post-dialysis body weight , serum albumin concentration ( nephelemetry ) , food intake assessed by a 3-day food question naire , nPNA ( normalized protein equivalent of nitrogen appearance ) , creatinine generation , and anthropometry . RESULTS Forty-five patients completed the study ( Group A : 14 F/9 M , 66.7 years old ; Group B : 11 F/11 M , 65.2 years old ) . At the beginning of the study , there were no differences between the groups for age , gender , HD duration , BMI , diabetes prevalence , plasma carnitine levels and measured nutritional parameters . 65.2 % and 77.3 % in each group were carnitine-deficient ( plasma total carnitine level < 35 micromol/l ) . After 6 months of L-carnitine supplementation , none of the nutritional parameters had changed in either group , except that serum albumin concentration decreased in both groups . Dividing each group according to their respective median serum albumin concentrations , daily energy and protein intakes , creatinine generation or triceps skinfold thickness did not show any difference in the various nutritional parameters with or without carnitine supplementation . CONCLUSION Carnitine supplementation , despite normalization of plasma carnitine levels , has no effect on the nutritional status of HD patients BACKGROUND Progressive loss of kidney function results in an increased risk of malnutrition . Despite this , there is little evidence informing the impact of nutrition intervention on predialysis patients with chronic kidney disease ( CKD ; stages 4 and 5 ) . STUDY DESIGN R and omized controlled trial . SETTING & PARTICIPANTS 56 out patients ( men , 62 % ; mean age , 70.7 + /- 14.0 [ SD ] years ) with CKD were r and omly allocated to intervention ( n = 29 ) or control ( n = 27 ) by using a concealed computer-generated sequence . INTERVENTION The intervention group , provided with individualized dietary counseling with regular follow-up aim ed at achieving an intake of 0.8 to 1.0 g/kg of protein and greater than 125 kJ/kg of energy , or control , receiving written material only . OUTCOMES & MEASURES Change in body composition ( body cell mass , measured by means of total-body potassium , in 40 of 56 participants ) , nutritional status ( Subjective Global Assessment ) , and energy and protein intake ( 3-day food record ) . RESULTS During the 12 weeks , the intervention group had 3.5 % ( 95 % confidence interval , -2.1 to 9.1 ) less decrease in body cell mass , 17.7-kJ/kg/d ( 95 % confidence interval , 8.2 to 27.2 ) greater increase in energy intake , greater improvement in Subjective Global Assessment ( P < 0.01 ) , and no significant difference in protein intake compared with the control group ( -0.04 g/kg/d ; 95 % confidence interval , -0.73 to 0.16 ) . The intervention was associated with greater increases in energy and protein intake in women than men ( interaction P < 0.001 for both ) . LIMITATIONS Power to detect change in body cell mass , potential bias in ascertainment of Subjective Global Assessment . CONCLUSIONS In predialysis patients with CKD , structured nutrition intervention had a greater effect on energy and protein intake in women than men . Additional investigations are warranted to determine the impact on body composition Background Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems . Amino acid deficiency , including L-carnitine , has been proposed to be associated with its pathophysiology . Nevertheless , the efficacy of L-carnitine supplementation on frailty status has not been documented . Thus , this study aim ed to determine the effect of 10-week L-carnitine supplement ( 1.5 g/day ) on frailty status and its biomarkers and also physical function , cognition , and nutritional status among prefrail older adults in Klang Valley , Malaysia . Methodology This study is a r and omized , double-blind , placebo-controlled clinical trial conducted among 50 prefrail subjects r and omized into two groups ( 26 in L-carnitine group and 24 in placebo group ) . Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit , selected frailty biomarkers ( interleukin-6 , tumor necrosis factor-alpha , and insulin-like growth factor-1 ) , physical function , cognitive function , nutritional status and biochemical profile . Results The results indicated that the mean scores of Frailty Index score and h and grip test were significantly improved in subjects supplemented with L-carnitine ( P<0.05 for both parameters ) as compared to no change in the placebo group . Based on Fried criteria , four subjects ( three from the L-carnitine group and one from the control group ) transited from prefrail status to robust after the intervention . Conclusion L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults Bicarbonate supplementation preserves renal function in experimental chronic kidney disease ( CKD ) , but whether the same benefit occurs in humans is unknown . Here , we r and omly assigned 134 adult patients with CKD ( creatinine clearance [ CrCl ] 15 to 30 ml/min per 1.73 m(2 ) ) and serum bicarbonate 16 to 20 mmol/L to either supplementation with oral sodium bicarbonate or st and ard care for 2 yr . The primary end points were rate of CrCl decline , the proportion of patients with rapid decline of CrCl ( > 3 ml/min per 1.73 m(2)/yr ) , and ESRD ( CrCl < 10 ml/min ) . Secondary end points were dietary protein intake , normalized protein nitrogen appearance , serum albumin , and mid-arm muscle circumference . Compared with the control group , decline in CrCl was slower with bicarbonate supplementation ( 5.93 versus 1.88 ml/min 1.73 m(2 ) ; P < 0.0001 ) . Patients supplemented with bicarbonate were significantly less likely to experience rapid progression ( 9 versus 45 % ; relative risk 0.15 ; 95 % confidence interval 0.06 to 0.40 ; P < 0.0001 ) . Similarly , fewer patients supplemented with bicarbonate developed ESRD ( 6.5 versus 33 % ; relative risk 0.13 ; 95 % confidence interval 0.04 to 0.40 ; P < 0.001 ) . Nutritional parameters improved significantly with bicarbonate supplementation , which was well tolerated . This study demonstrates that bicarbonate supplementation slows the rate of progression of renal failure to ESRD and improves nutritional status among patients with CKD Cardiovascular disease is more common in patients with chronic kidney disease ( CKD ) , and traditional risk factors do not adequately predict those at risk for cardiovascular ( CV ) events . Recent evidence suggests elevated  trimethylamine N-oxide ( TMAO )  , created by gut microflora from dietary L-carnitine and choline , is associated with CV events . We investigated the relationship of TMAO levels in patients with stages 3b and 4 CKD to ischemic CV events using the CanPREDDICT cohort , a Canada-wide observational study with prospect i ve 3-year follow-up of adjudicated CV events . Baseline sample s were obtained for 2529 CKD patients .  TMAO , choline , and L-carnitine levels  were measured using t and em mass spectrometry . Baseline median TMAO level was high for the whole cohort ( 20.41 μM ; interquartile range [ IQR ] : 12.82 - 32.70 μM ) . TMAO was independently associated with CV events ( hazard ratio 1.23 ; 95 % confidence interval : 1.06 - 1.42 / 1 SD lnTMAO ) after adjusting for all potential CV risk factors . Those in the highest TMAO quartile had significantly higher risk of CV events ( adjusted hazard ratio 1.59 ; 95 % confidence interval : 1.04 - 2.43 ; P = 0.0351 ) in the analysis of recurring ischemic events . Among those with stage 3b CKD ( hazard ratio 1.45 ; 95 % confidence interval : 1.12 - 1.87 / 1 SD lnTMAO ) , independent of kidney function , TMAO levels identified those at highest risk for events . Our results suggest that TMAO may represent a new potentially modifiable CV risk factor for CKD patients . Further studies are needed to determine sources of variability and if lowering of TMAO reduces CV risk in CKD End-stage renal disease affects every aspect of a patient 's life , including perception of health and quality of life . It is likely that a hemodialysis patient 's perceptions of health-related quality of life directly influence compliance with medical , nursing , and nutritional prescriptions . Because L-carnitine supplementation is known to enhance muscle strength and energy in hemodialysis patients , we hypothesized that L-carnitine supplementation would enhance a hemodialysis patient 's perception of health-related quality of life . To test this hypothesis , 1 g L-carnitine or placebo was administered orally to 101 patients immediately before and after every hemodialysis treatment for 6 months . To assess health-related quality of life from the patient 's perspective , the Medical Outcomes Study Short Form 36 instrument was administered before the study and at 1.5-month intervals for the duration of the study . In addition , a 10-item question naire design ed to assess common intradialytic symptoms was administered at the end of each dialysis treatment . Other parameters analyzed included Kt/V(urea ) and level of nutrition . In the 6-month group , oral L-carnitine supplementation had an early positive effect on general health ( P < 0.02 ) and physical function ( P < 0.03 ) , but the perceived effect was not sustained throughout the 6 months of the study . In the 3-month group , L-carnitine supplementation improved vitality ( P < 0.02 ) and general health ( P < 0.01 ) . There was no association between Kt/V(urea ) and perceived health-related quality of life . Serum albumin concentration was directly correlated to how patients perceived the quality of their lives Objective : To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids ( VLPD+KA ) in comparison with a conventional low-protein diet ( LPD ) in chronic kidney disease ( CKD ) patients . Design : Prospect i ve , r and omized , controlled clinical study . Setting : Outpatient Clinic of the Nephrology Division of Federal University of São Paulo , Brazil . Subjects : The study involved 24 patients with advanced CKD ( creatinine clearance < 25 ml/min ) that were r and omly assigned to either a VLPD+KA ( VLPD+KA group , 12 patients ) or to a conventional LPD with 0.6 g/kg/day ( LPD group , 12 patients ) . The patients were followed for 4 months . Results : Nutritional status was adequately maintained with both diets for the studied period . Protein intake and serum urea nitrogen decreased significantly only in the VLPD+KA group ( from 0.68±0.17 to 0.43±0.12 g/kg/day , P<0.05 ; from 61.4±12.8 to 43.6±14.9 mg/dl , P<0.001 ; respectively ) . Ionized calcium did not change in the VLPD+KA group but tended to decrease in the LPD group . Serum phosphorus tended to decrease in the VLPD+KA group probably as a result of a significant reduction in dietary phosphorus ( 529±109 to 373±125 mg/day , P<0.05 ) associated to the phosphorus-binding effect of the ketoacids . No change in these parameters was found in the LPD group . Serum parathormone increased significantly only in the LPD group ( from 241±138 to 494±390 pg/ml , P<0.01 ) . The change in PTH concentration was negatively correlated with changes in ionized calcium concentration ( r=−0.75 , P=0.02 ) and positively correlated with changes in serum phosphorus ( r=0.71 , P=0.03 ) only in the LPD group . Conclusion : This study indicates that a VLPD+KA can maintain the nutritional status of the patients similarly to a conventional LPD . Besides , an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD+KA . Thus , VLPD+KA can constitute another efficient therapeutic alternative in the treatment of CKD patients .Sponsorship : This study was supported by CAPES , Oswaldo Ramos Foundation and Fresenius Kabi , Ltda To investigate whether L-carnitine supplementation may correct nutritional carnitine deficiency and associated metabolic disturbances in premature infants receiving total parenteral nutrition , an intravenous fat tolerance test ( 1 gm/kg Intralipid over four hours ) was performed in 29 premature infants 6 to 10 days of age ( 15 receiving carnitine supplement 10 mg/kg . day L-carnitine IV , and 14 receiving no supplement ) .  Total carnitine plasma values were normal or slightly elevated in supplemented but decreased in nonsupplemented infants . In both groups , fat infusion result ed in an increase in plasma concentrations of triglycerides , free fatty acids , D-beta-hydroxybutyrate , and short-chain and long-chain acylcarnitine , but total carnitine values did not change . After fat infusion , the free fatty acids/D-beta-hydroxybutyrate ratios were lower and the increase of acylcarnitine greater in supplemented infants of 29 to 33 weeks ' gestation than in nonsupplemented infants of the same gestational age . This study provides evidence that premature infants of less than 34 weeks ' gestation requiring total parenteral nutrition develop nutritional carnitine deficiency with impaired fatty acid oxidation and ketogenesis .  Carnitine supplementation improves this metabolic disturbance OBJECTIVE We assessed the effect of a severe hypoproteic diet supplemented with ketoanalogues ( SVLPD ) for 48 weeks on certain metabolic disorders of chronic kidney disease ( CKD ) . DESIGN We performed a prospect i ve , open-label , parallel , r and omized , controlled trial . SETTING The study took place in the Nephrology Department at the Dr Carol Davila Teaching Hospital of Nephrology , Bucharest , Romania . PATIENTS A total of 53 nondiabetic patients with CKD with an estimated glomerular filtration rate less than 30 mL/min/1.73 m(2 ) ( Modification of Diet in Renal Disease formula ) , proteinuria less than 1 g/g urinary creatinine , good nutritional status , and anticipated good compliance with the diet were r and omly assigned to two groups . INTERVENTION Group I ( n = 27 ) received the SVLPD ( 0.3 g/kg/d of vegetable proteins and ketoanalogues , 1 capsule for every 5 kg of ideal body weight per day ) . Group II ( n = 26 ) continued a conventional low mixed protein diet ( 0.6 g/kg/d ) . OUTCOME MEASURES Nitrogen waste products retention and calcium-phosphorus and acid-base disturbances were primary efficacy parameters , and " death " of the kidney or the patient and the estimated glomerular filtration rate were secondary efficacy parameters . The nutritional status and compliance with the diet were predefined as safety variables . There were no differences between groups in any parameter at baseline . RESULTS In the SVLPD group , serum urea significantly decreased ( 56 + /- 7.9 mmol/L vs. 43.2 + /- 10 mmol/L ) , and significant improvements in serum bicarbonate ( 23.4 + /- 2.1 mmol/L vs. 18.1 + /- 1.5 mmol/L ) , serum calcium ( 1.10 + /- 0.17 mmol/L vs. 1.00 + /- 0.15 mmol/L at baseline ) , serum phosphates ( 1.45 + /- 0.66 mmol/L vs. 1.91 + /- 0.68 mmol/L ) , and calcium-phosphorus product ( 1.59 + /- 0.11 mmol(2)/L(2 ) vs. 1.91 + /- 0.10 mmol(2)/L(2 ) ) were noted after 48 weeks . No death was registered in any group . Significantly lower percentages of patients in group I required renal replacement therapy initiation ( 4 % vs. 27 % ) . After 48 weeks , estimated glomerular filtration rate did not significantly change in patients receiving SVLPD ( 0.26 + /- 0.08 mL/s vs. 0.31 + /- 0.08 mL/s at baseline ) , but significantly decreased in controls ( 0.22 + /- 0.09 mL/s vs. 0.30 + /- 0.07 mL/s ) . The compliance with the keto-diet was good in enrolled patients . No significant changes in any of the parameters of the nutritional status and no adverse reactions were noted . CONCLUSION SVLPD seems to ameliorate the nitrogen waste products retention and acid-base and calcium-phosphorus metabolism disturbances and to postpone the renal replacement therapy initiation , preserving the nutritional status in patients with CKD
Having this evidence s , the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined
Protein energy malnutrition is a common problem in patients with chronic kidney disease ( CKD ) .
Scattered reports indicate that supplementation of Carnitine may improve patients ' clinical symptoms , with significant improvement in nutritional parameters .
This systematic review was done to document the evidence s of Carnitine effects in nutritional status of CKD patients .