Department of Nephrology, Daimon Clinic for Internal Medicine, Nephrology and Dialysis, Nonoichi, Japan.
Ther Apher Dial. 2022 Feb;26(1):122-129. doi: 10.1111/1744-9987.13638. Epub 2021 Mar 31.
Mechanisms of impaired fatty acid metabolism may not be the same in nondialysis and hemodialysis patients. Correlations between the serum-free carnitine concentration (FC), acylcarnitine concentration (AC), acyl to free carnitine ratio (AC/FC), and estimated glomerular filtration rate (eGFR) in the nondialysis population and the duration of hemodialysis in hemodialysis patients were investigated. As the eGFR decreased, the FC and AC increased, and as the duration of hemodialysis became longer, the FC and AC decreased. The AC/FC increased consistently as the eGFR decreased and the duration of hemodialysis increased. As an exception, the AC/FC decreased in the patients with a hemodialysis duration less than 90 days, which was not explained by carnitine removal by hemodialysis. In nondialysis patients, a functional, rather than an absolute, carnitine deficiency is a main cause of impaired fatty acid metabolism. Long-term hemodialysis exacerbates absolute carnitine deficiency, whereas hemodialysis treatment may improve impaired fatty acid metabolism.
脂肪酸代谢受损的机制在非透析患者和血液透析患者中可能并不相同。研究了非透析人群中血清游离肉碱浓度（FC）、酰基肉碱浓度（AC）、酰基/游离肉碱比值（AC/FC）与估算肾小球滤过率（eGFR）之间的相关性，以及血液透析患者血液透析时间的相关性。随着 eGFR 的降低，FC 和 AC 增加，随着血液透析时间的延长，FC 和 AC 降低。AC/FC 随着 eGFR 的降低和血液透析时间的延长而持续增加。作为一个例外，血液透析时间小于 90 天的患者的 AC/FC 降低，这不能用血液透析去除肉碱来解释。在非透析患者中，功能性而非绝对的肉碱缺乏是脂肪酸代谢受损的主要原因。长期血液透析会加重绝对肉碱缺乏，而血液透析治疗可能会改善脂肪酸代谢受损。
