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L‐carnitine supplementation in the dialysis population: Are Australian patients missing out? (Review Article)
Author(s) -
REUTER STEPHANIE E,
FAULL RANDALL J,
EVANS ALLAN M
Publication year - 2008
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2007.00817.x
Subject(s) - medicine , carnitine , dialysis , erythropoietin , population , intensive care medicine , medicaid , health care , environmental health , economics , economic growth
SUMMARY: It has been widely established that patients with end‐stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L‐carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin‐resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L‐carnitine for the treatment of erythropoietin‐resistant anaemia and/or intradialytic hypotension in patients with low endogenous L‐carnitine concentrations. It has been estimated that in the period of 1998–2003, 3.8–7.2% of all haemodialysis patients in the USA received at least one dose of L‐carnitine, with 2.7–5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L‐carnitine within Australia is virtually non‐existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L‐carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting.