Impact of hemodialysis on endogenous plasma and muscle carnitine levels in patients with end-stage renal disease

Allan M. Evans, Randall J. Faull, Roger L. Nation, Shilpanjali Prasad, Tony Elias, Stephanie E. Reuter, Gianfranco Fornasini

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54 Citations (Scopus)


Background. End-stage renal disease (ESRD) patients undergoing hemodialysis treatment have reduced plasma L-carnitine levels; however, the relationship between dialysis age and carnitine status is poorly understood. This study examined the relationship between duration of dialysis and plasma and skeletal muscle concentrations of L-carnitine and its esters in ESRD patients. Methods. Blood samples were collected from 21 patients at baseline and throughout the first 12 months of hemodialysis. In 5 patients, muscle samples were obtained after 0, 6, and 12 months of hemodialysis. Blood and muscle samples were collected from an additional 20 patients with a mean dialysis age of 5.10 years. L-carnitine, acetyl-L-carnitine, and total L-carnitine were measured by high-performance liquid chromatography (HPLC). Results. The mean ± SD plasma L-carnitine concentration in ESRD patients who had not yet started hemodialysis was 50.6 ± 20.0 μmol/L. Significantly lower concentrations were observed after 12 months (29.7 ± 10.5 μmol/L) and <12 months (22.0 ± 5.4 μmol/L) of hemodialysis treatment. Acetyl-L-carnitine also declined with dialysis age, while plasma nonacetylated acylcarnitines continued to increase with the progression of hemodialysis therapy. An inverse relationship between dialysis age and muscle L-carnitine concentrations was observed. Conclusion. Long-term hemodialysis treatment is associated with a significant reduction in endogenous plasma and muscle L-carnitine levels and a significant increase in plasma acylcarnitines. The majority of the change in plasma L-carnitine concentrations occurs within the first few months of hemodialysis, while muscle levels continue to decline after 12 months of treatment.

Original languageEnglish
Pages (from-to)1527-1534
Number of pages8
JournalKidney International
Issue number4
Publication statusPublished or Issued - Oct 2004
Externally publishedYes


  • Acetyl-L-carnitine
  • End-stage renal disease
  • Hemodialysis
  • L-carnitine
  • Plasma
  • Skeletal muscle

ASJC Scopus subject areas

  • Nephrology

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