NDT Advance Access published online on July 5, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl312
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1 Division of Pediatric Nephrology, Toronto General Hospital, Toronto, Canada
* To whom correspondence should be addressed. 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.
Received January 25, 2006
Accepted May 3, 2006
Brief Report
Short-term effects of nocturnal haemodialysis on carnitine metabolism
Daljit K. Hothi 1,
Denis F. Geary 1,
Lawrence Fisher 2,
and
Christopher T. Chan 3 *
2 Department of Biochemistry, Hospital for Sick Children, Toronto General Hospital, Toronto, Canada
3 Department of Nephrology, Toronto General Hospital, Toronto, Canada
Christopher T. Chan, E-mail: Christopher.Chan{at}uhn.on.ca
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