Letter to the Editor NEPHRON Nephron 1996;72:341-342 N. Yllmaz Selfuk 3 Ayla San 3 H. Zeki Tonbula Hiilya Aksoyb Ilhami Ika a Ebubekir Bakanh Departments of Nephrology and Clinical Biochemistry. Research Hospital, Atatiirk University Medical Faculty, Erzurum, Turkey Effects of Nutritional Status and Oral Essential Amino Acid Replacement on Serum ¿-Carnitine Levels of Chronically Hemodialyzed Patients Table 1. Serum /„-carnitine levels (pmol/1) of the patients accord ing to sex and nutritional status (mean ± SD) Parameters L-Camitine p value Sex Male (n = 11) 59 ±32.5 >0.05 Female (n = 16) 54 ±20 BMI < 20 kg/m2 (n = 9) 40 ±21 <0.02 > 20 kg/m2 (n= 18) 65 ±24 NPCR < 1 g/kg/day (n = 18) 44 ± 21 <0.001 > 1 g/kg/day (n = 9) 81 ± 15 EAS recipients (n = 18) 65 ±24 No EAS recipients (n = 9) 40 ±21 <0.02 Dear Sir, Predialysis serum L-camitine levels have been found to be low [ 1 ]. normal [2] and high [3] in regularly hemodialyzed patients. In humans, carnitine is synthesized in the liver and kidney from methionine and lysine ami no acids, and taken up via dietary meat and milk products [4], The aim of this study is to determine whether there is any effect of nu tritional status and oral intake of carnitine precursors on serum L-camitine levels of chronically hemodialyzed patients. This study included 27 (16 males) chron ically hemodialyzed patients (GFR = 8.5 ± 2.7 ml/min/1.73 m2) and 15 (8 males) healthy volunteers. The patients have been on hemodialysis (HD) thrice weekly (4 h each dialysis) for 16 months (range 2-66) with a I-m2 cuprophane hollow-fiber dialyz- er and acetate-containing dialysate. None of the patients had hepatic failure, and 18 pa tients were taking oral tablets (3 x 2 per day) containing essential amino acids (EAS; Fre- senius AG; methionine = 52 mg/tablct, ly sine = 75 mg/tablet). Following an overnight fast, blood samples were taken at the begin ning of a morning HD session. An L-cami tine enzymatic UV test kit (Bochringcr- Mannheim; Cat. No. 1242008) was used for the determination of serum L-camitine lev els. Mean body mass index (BMI), serum albumin level and normalized protein catab olism rate (NPCR), which are some nutri tional indexes, of the patients were within the normal range (21 ± 2.7 kg/m2, 36 ± 3 g/ 1,0.9 ± 0.1 g/kg/day, respectively). Predialysis serum L-camitine levels of the patients (56 ± 25 pmol/1) were higher than those of controls (31 ± 9 pmol/1; p < 0.001). We determined serum L-carnitinc levels in 12 patients before and after an HD session (62 ± 24 and 26 ± 24 pmol/1. re spectively) and found a decrease of 60 ± 33% after HD. Serum L-camitine levels were higher in patients with good nutritional state taking EAS tablets and were not differ ent with respect to sex (table 1). Fagher et al. [5] could not detect any sig nificant effect of L-camitine supplementa tion on many clinical and metabolic abnor malities of patients on maintainance HD. However, they pointed out that their pa tients were in a good nutritional state and apparently not carnitine deficient. Finally, in the present study, it was shown that serum L-camitine levels in chronically hemodialyzed patients, who had a better nutritional status and took carnitine percursors. were higher than those of the oth ers. More detailed studies should be done on this subject. KARGER E-Mail kargcr(akarger.ch Fax+ 41 61 306 12 34 ® 1996 S. Karger AG. Basel 0028-2766/96/0722-0341 $8.00/0 Dr. N. Yilmaz Selçuk Atatiirk Oniversitcsi Tip Fakiiltcsi lç Hastaliklan TR-25240 Erzurum (Turkey)