透析患者におけるｃａｒｎｉｔｉｎｅとその補充による脂質代謝への影響　　透析量の異なる２病院での検討

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  • Clinical study of serum carnitine level and lipid effects on long-term hemodialysis patients administered L-carnitine: Comparison of dialysis dose patients between hospitals A and B.
  • Comparison of dialysis dose patients between hospitals A and B
  • 透析量の異なる2病院での検討

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L-carnitine facilitates the entry of long chain fatty acids into mitochondria, where they are oxidized to produce energy for muscles and other cells. Insufficient carnitine may lead to an accumulation of fatty acid, which has toxic effects on cell function and may create an energy deficit within cells. Dialysis patients are allowed limited quantities of carnitine-rich food items.<br>It is a well-known fact that this 162-dalton water-soluble quaternary amine is easily dialyzed, and losses during the dialysis procedure increase the propensity for deficiency and/or depletion. We studied serum carnitine levels in 37 dialysis patients (A hosp: 13 cases, Kt/V=1.67; B hosp: 24 cases, Kt/V=2.24) who were administered L-carnitineTM at doses of 500-1000mg/day, and measured the dialysate concentration of carnitine to determine whether the supplementary dose of L-carnitine was adequate. Serum lipoprotein changes were examined in 13 dialysis patients at hospital A. Short-term L-carnitine administration increased plasma-free carnitine (FC) and total carnitine (TC) levels, but the AC/FC ratio improved only slighty from 0.84 to 0.69 (normal: 0.16). The deficiency and depletion of carnitine was more significant in patients recieving a large dialysis dose. The concentration of plasma lipids such as HDL, LDL, VLDL, and TG were unexpectedly elevated following short-term carnitine administration. However, in this study the plasma level of Malondialdehyde-LDL (MDA-LDL) decreased significantly, but the decrease in the Oxidized-LDL (OX-LDL) plasma level was not significant. In consideration of all these results, we concluded that a lower dose of carnitine (<5mg/kg, 500mg/every other day) might be more reliable in correcting lipid abnormalities, but the antioxidant effect on lipid metabolism might be weak.

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