NDT Advance Access originally published online on July 5, 2006
Nephrology Dialysis Transplantation 2006 21(9):2637-2641; doi:10.1093/ndt/gfl312
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Short-term effects of nocturnal haemodialysis on carnitine metabolism
1 Division of Pediatric Nephrology, 2 Department of Biochemistry, Hospital for Sick Children and 3 Department of Nephrology, Toronto General Hospital, Toronto, Canada
Correspondence and offprint requests to: Dr Christopher T. Chan, 200 Elizabeth Street, 8N – room 842, Toronto, Ontario M5G 2C4, Canada. Email: Christopher.Chan{at}uhn.on.ca
Background. Functional carnitine deficiency [as indicated by an abnormal acyl-carnitine/free-carnitine (AC:FC) ratio] is commonly seen in patients with end-stage renal disease (ESRD), resulting in significant clinical detriments including anaemia, cardiomyopathy and muscle weakness. Nocturnal haemodialysis (NHD) (5–6 sessions per week, 8 h per treatment) has been reported to reverse several surrogate markers of uraemia. Conversely, as a consequence of increased dialysis dose, NHD may have the potential to aggravate plasma nutrient deficiencies. Our objective was to determine the effects of NHD on plasma free-carnitine levels and carnitine metabolism.
Methods. We conducted an observational cohort study with a before and after design. Nine ESRD patients (age: 47 ± 3; mean ± SEM) were studied. Routine biochemical, haemodynamic and carnitine metabolic products were analysed at baseline while on conventional haemodialysis and 2 months post-conversion to NHD. Free-carnitine and total-carnitine levels were generated by colorimetric assays. The difference between total- and free-carnitine concentrations was estimated to be the acyl-carnitine level. Paired t-test was used to ascertain statistical significance.
Results. After conversion to NHD, there was a significant increase in urea clearance in all patients. Plasma free-carnitine levels fell from 26.54 ± 2.99 to 15.6 ± 2.34 µmol/l (P < 000.1). A similar reduction in plasma acyl-carnitine levels was observed (from 13.22 ± 1.34 to 6.24 ± 1.20 µmol/l (P < 0.001)). The AC:FC ratio improved from 0.51 ± 0.03 to 0.39 ± 0.03 (P < 0.005) (Normal < 0.25).
Conclusion. NHD is associated with an improvement in AC:FC ratio. Further research is needed to examine the longitudinal clinical impact of this metabolic correction and to examine whether this effect is sustained.
Keywords: carnitine; metabolism; nocturnal haemodialysis; uraemia
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