L-carnitine addition to dialysis fluid. A therapeutic alternative for hemodialysis patients.

L-Carnitine has been reported to have beneficial effects in the reduction of serum triglycerides and increases high-density lipoprotein cholesterol in hemodialysis patients. The published reports are, however, equivocal. Paradoxical increases in serum triglycerides following intravenous administration of L-carnitine have been observed. It has been suggested that the paradoxical rise in triglycerides may result from the high doses used and intravenous administration, both of which may cause abnormally high tissue concentrations. In the present study 22 hemodialysis patients were selected. All patients had been treated intravenously with 2 g of L-carnitine administered at the end of dialysis for a minimum of 12 months. Treatment with L-carnitine was then discontinued during a 4-month washout period. The patients were then divided into two equal subgroups and placed on L-carnitine therapy (1 g i.v.) at the end of dialysis for 1 month. Thereafter, L-carnitine was added to the dialysate (2 g in group 1, 4 g in group 2) for 3 months. Serum and muscle carnitine levels were determined throughout the study as were lipid parameters, serum chemistry, and hematology. Muscle biopsies obtained at baseline revealed supranormal levels of carnitine which decreased to normal levels following the 4-month washout period. When therapy with L-carnitine was resumed, intravenous administration or in dialysate, the muscle carnitine levels remained within the normal range. Similarly, serum carnitine was markedly elevated at baseline and decreased to normal during the washout period. When L-carnitine was added to the dialysate, total carnitine was observed to significantly increase in the group receiving 4 g.(ABSTRACT TRUNCATED AT 250 WORDS)