Zilleruelo G, Novak M, Hsia S L, Goldberg R, Abitbol C, Monkus E, Strauss J
Department of Pediatrics, University of Miami School of Medicine, Florida.
Kidney Int Suppl. 1989 Nov;27:S259-63.
Cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response in hyperlipidemia. We have compared in a double-blind, cross-over study the effect of dialysate buffer composition (acetate or bicarbonate) on the serum lipid response to L-carnitine supplementation during hemodialysis. We studied nine patients (mean age, 19 years; range, 14 to 23) with hyperlipidemia undergoing maintenance hemodialysis. Plasma levels of carnitines and lipids, including total and HDL cholesterol (HDL-C) and triglycerides (TG), were measured at baseline and monthly intervals after receiving 2 grams of L-carnitine or placebo added to dialysis bath for three months. One month of carnitine supplementation in acetate hemodialysis significantly reduced plasma TG (230 +/- 95 to 136 +/- 20 mg/dl; P less than 0.05) and elevated HDL-C (50 +/- 12 to 71 +/- 26 mg/dl; P less than 0.05). However, this effect was no longer observed at the end of three months of supplementation. Bicarbonate hemodialysis had lower baseline TG values, but carnitine supplementation did not modify plasma lipids (TG:144 +/- 87 to 158 +/- 115 mg/dl; HDL-C:50 +/- 23 to 50 +/- 19 mg/dl). Both groups had a significant increase in plasma carnitine levels after carnitine supplementation. These results suggest that bicarbonate hemodialysis may add a protective effect in hyperlipidemia by reducing requirements of carnitine supplementation. On the other hand, carnitine supplementation should be considered in patients with hyperlipidemia undergoing acetate hemodialysis. The observed difference in response between acetate and bicarbonate hemodialysis may be due to enhanced formation of acetyl-CoA and fatty acid synthesis during acetate hemodialysis.
通过透析膜的累积肉碱损失可能会使长期血液透析期间的高脂血症恶化。然而，补充肉碱在高脂血症中并未显示出一致的有益反应。我们在一项双盲、交叉研究中比较了透析液缓冲液成分（醋酸盐或碳酸氢盐）对血液透析期间补充L-肉碱后血清脂质反应的影响。我们研究了9例接受维持性血液透析的高脂血症患者（平均年龄19岁；范围14至23岁）。在将2克L-肉碱或安慰剂添加到透析液中三个月后，在基线和每月间隔时测量肉碱和脂质的血浆水平，包括总胆固醇和高密度脂蛋白胆固醇（HDL-C）以及甘油三酯（TG）。在醋酸盐血液透析中补充一个月肉碱可显著降低血浆TG（230±95至136±20mg/dl；P<0.05）并升高HDL-C（50±12至71±26mg/dl；P<0.05）。然而，在补充三个月结束时不再观察到这种效果。碳酸氢盐血液透析的基线TG值较低，但补充肉碱并未改变血浆脂质（TG：144±87至158±115mg/dl；HDL-C：50±23至50±19mg/dl）。补充肉碱后两组的血浆肉碱水平均显著升高。这些结果表明，碳酸氢盐血液透析可能通过减少肉碱补充需求对高脂血症起到保护作用。另一方面，对于接受醋酸盐血液透析的高脂血症患者应考虑补充肉碱。观察到的醋酸盐和碳酸氢盐血液透析之间的反应差异可能是由于醋酸盐血液透析期间乙酰辅酶A形成增加和脂肪酸合成增强所致。
