1496 Carnitine deficiency induced during hemodialysis and hyperlipidemia: effect of replacement therapy3 Massimo Bertoli, M.D., Pier A. Battistella, M.D., Ludovica Vergani, M.S., Agostino Naso, M.D., Maria L. Gasparotto, M.D., Gian F. Romagnoli, M.D., and Corrado A ngelini, M.D. ABSTRACT Plasma carnitine levels were studied in 14 uremic patients before, during, and after hemodialysis. The prediahysis plasma carnitine levels were normal but fell during dialysis (half-life 3.6 h). Plasma carnitine levels rose quickly in the first 6 h after dialysis, after which time the rise was more gradual. Muscle carnitine was significantly reduced in the dialyzed patients (p < 0.005) compared with controls. In four patients lipid droplets were observed in muscle. Ten patients on maintenance hemodialysis exhibited plasma hyperlipidemia and low muscle carnitine. These individuals were given DL-carnitine (50 mg/kg body weight) intravenously after each dialysis. At the end of a 2-month carnitine treatment, plasma triglyceride levels were found to be reduced (p <0.001) and muscle carnitine content significantly increased (p < 0.005). These findings suggest that carnitine may be useful in treatment of hypertriglyceridemia and muscle carnitine deficiency states induced during maintenance hemodialysis. Am. J. Clin. Nuir. 34: 1496-1500. 1981. KEY WORDS: Hemodialysis, carnitine, hypertriglyceridemia. muscle lipid storage Introduction Carnitine is a quaternary ammoniacal compound essential for the transport of fatty acids to mitochondrial oxidation sites. Re- duced tissue concentrations of carnitine cause accumulation of free fatty acids and lipid storage in muscle and other tissues (1, 2). Carnitine retention has been observed in patients with chronic renal failure, since this metabolite is excreted by the kidney (3, 4). It has recently reported by B#{246}hmer et al. (5) and Battistella et al. (6) that plasma and muscle carnitine levels fall below normal in uremic patients on maintenance hemodi- alysis. We studied plasma and muscle carni- tine levels in two groups of patients with chronic uremia in order to determine whether dialysis caused carnitine depletion and if this was related to the dyslipidemia frequently present in these patients. DL-Carnitine was used to treat the hyperlipidemia and this therapy significantly increased the tissue car- nitine contents. Materials and methods Plasma and muscle carnitine were determined in four male patients (aged 27 to 64 yr) with terminal renal failure but not yet on dialysis (creatininemia 10 mg/ dl). We also evaluated 14 patients (aged 24 to 60 yr) with chronic uremia who had undergone hemodialysis for periods from 6 to 61 months. In both groups of patients plasma cholesterol and triglycerides were assayed by autoanalyzer. Ten patients on maintenance hemodialysis had displayed marked hypertriglyceridemia. They were treated with intravenous DL-carnitine (50 mg/kg) after each dialysis (DL-carnitine hydrochloride was kindly sup- plied by Sigma-Tau, Rome, Italy, in 1.0 g sealed am- pouhes). Plasma and muscle carnitine, as well as plasma lipids, were measured after 60 days of treatment. Plasma carnitine was also determined in 27 healthy volunteers (13 males and 14 females, aged 20 to 50 yr). Muscle samples were taken by percutaneous needle biopsy (Tro-cut Travenoh) from the vastus lateralis mus- cle and immediately frozen. The muscle specimens were obtained from dialysis patients before therapy and at the end of 2 months of treatment, 24 h after the last carnitine load. A fragment was used for the measurement of muscle-free carnitine according to the radiochemical method of Cederblad and coworkers (7, 8). Routine histochemical stains and Oil-Red-O stain for lipids were performed on cryostat sections. From the Haemodialysis Service and the Neurolog- ical Department, University Hospital of Padua, Padua, Italy. 2 Supported in part by M.D.A. grant and by C.N.R. Grant 790182204 to C. A. Address reprint requests to: C. Angehini M.D., Chin- ica Neurologica, Universit#{224} di Padova, v.Giustiniani 5, 35100 Padova, Italy. The American Journal of Clinical Nutrition 34: AUGUST 1981, pp. 1496-1500. Printed in U.S.A. © 1981 American Society for Clinical Nutrition at UNIV DEGLI STUDI DI PADOVA (UNIPD) on August 14, 2015 ajcn.nutrition.org Downloaded from