L-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients. Nutritional effects of carnitine supplementation in hemodialysis patients. Randomized controlled trial of nutritional counseling on body composition and dietary intake in severe CKD. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial Bicarbonate supplementation slows progression of CKD and improves nutritional status. Advanced chronic kidney disease populations have elevated trimethylamine N-oxide levels associated with increased cardiovascular events. Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation. Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation. Effects of a supplemented hypoproteic diet in chronic kidney disease. Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study. L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN) - a randomized multicentre trial Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome. The use of an anti-inflammatory supplement in patients with chronic kidney disease Arsenic and Chronic Kidney Disease: A Systematic Review Carnitine supplementation in premature neonates: effect on plasma and red blood cell total carnitine concentrations, nutrition parameters and morbidity. Parenteral nutrition in preterm neonates with and without carnitine supplementation Effects of Probiotic Supplementation on Trimethylamine-N-Oxide Plasma Levels in Hemodialysis Patients: a Pilot Study Effectiveness of a nutrition education program for the prevention and treatment of malnutrition in end-stage renal disease. A pilot study on the effects of curd (dahi) & leaf protein concentrate in children with protein energy malnutrition (PEM). Effect of L-carnitine supplementation in comparison with moderate aerobic training on serum inflammatory parameters in healthy obese women. Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition.
Scattered reports indicate that L-carnitine may suppress proinflammatory cytokines in sick individuals without renal disease and may improve protein synthesis or nitrogen balance either in patients without renal disease or in maintenance hemodialysis ( MHD ) or chronic peritoneal dialysis patients . We conducted an experimental study in MHD patients to evaluate the effects of L-carnitine treatment on inflammatory and protein-energy nutritional status .  MHD patients were assigned to receive intravenous injections of L-carnitine 20 mg/kg ( n = 48 ) or placebo ( n = 65 ) thrice weekly at the end of each hemodialysis treatment for 6 months . The carnitine-treated group showed a statistically significant decrease in serum C-reactive protein and increase in serum albumin and transferrin , blood hemoglobin , and body mass index . Conversely , in the placebo-treated group , a significant decrease was reported for serum albumin , serum transferrin , and body mass index , whereas the other considered measures did not change significantly . These preliminary findings suggest that in MHD patients , L-carnitine therapy may suppress inflammation , particularly among those patients with C-reactive protein > or =3 mg/dL , and may improve protein-energy nutritional status AIMS Carnitine is involved in fatty acid metabolism and it is cleared by dialysis . As it plays a role in energy utilization and because malnutrition is a frequent complication of HD treatment , we studied the effects of carnitine supplementation on several nutritional parameters in HD patients . MATERIAL AND METHODS The main selection criterion was a body mass index ( BMI ; body weight/(height)2 ) < 22 kg/m2 . Fifty-three patients were enrolled to participate in this open and r and omized study . For 6 months , 28 patients received 15 mg/kg of intravenous L-carnitine at the end of each  hemodialysis ( HD ) treatment  ( Group A ) , the remaining 25 patients were controls ( Group B ) . The measured parameters were the post-dialysis body weight , serum albumin concentration ( nephelemetry ) , food intake assessed by a 3-day food question naire , nPNA ( normalized protein equivalent of nitrogen appearance ) , creatinine generation , and anthropometry . RESULTS Forty-five patients completed the study ( Group A : 14 F/9 M , 66.7 years old ; Group B : 11 F/11 M , 65.2 years old ) . At the beginning of the study , there were no differences between the groups for age , gender , HD duration , BMI , diabetes prevalence , plasma carnitine levels and measured nutritional parameters . 65.2 % and 77.3 % in each group were carnitine-deficient ( plasma total carnitine level < 35 micromol/l ) . After 6 months of L-carnitine supplementation , none of the nutritional parameters had changed in either group , except that serum albumin concentration decreased in both groups . Dividing each group according to their respective median serum albumin concentrations , daily energy and protein intakes , creatinine generation or triceps skinfold thickness did not show any difference in the various nutritional parameters with or without carnitine supplementation . CONCLUSION Carnitine supplementation , despite normalization of plasma carnitine levels , has no effect on the nutritional status of HD patients BACKGROUND Progressive loss of kidney function results in an increased risk of malnutrition . Despite this , there is little evidence informing the impact of nutrition intervention on predialysis patients with chronic kidney disease ( CKD ; stages 4 and 5 ) . STUDY DESIGN R and omized controlled trial . SETTING & PARTICIPANTS 56 out patients ( men , 62 % ; mean age , 70.7 + /- 14.0 [ SD ] years ) with CKD were r and omly allocated to intervention ( n = 29 ) or control ( n = 27 ) by using a concealed computer-generated sequence . INTERVENTION The intervention group , provided with individualized dietary counseling with regular follow-up aim ed at achieving an intake of 0.8 to 1.0 g/kg of protein and greater than 125 kJ/kg of energy , or control , receiving written material only . OUTCOMES & MEASURES Change in body composition ( body cell mass , measured by means of total-body potassium , in 40 of 56 participants ) , nutritional status ( Subjective Global Assessment ) , and energy and protein intake ( 3-day food record ) . RESULTS During the 12 weeks , the intervention group had 3.5 % ( 95 % confidence interval , -2.1 to 9.1 ) less decrease in body cell mass , 17.7-kJ/kg/d ( 95 % confidence interval , 8.2 to 27.2 ) greater increase in energy intake , greater improvement in Subjective Global Assessment ( P < 0.01 ) , and no significant difference in protein intake compared with the control group ( -0.04 g/kg/d ; 95 % confidence interval , -0.73 to 0.16 ) . The intervention was associated with greater increases in energy and protein intake in women than men ( interaction P < 0.001 for both ) . LIMITATIONS Power to detect change in body cell mass , potential bias in ascertainment of Subjective Global Assessment . CONCLUSIONS In predialysis patients with CKD , structured nutrition intervention had a greater effect on energy and protein intake in women than men . Additional investigations are warranted to determine the impact on body composition Background Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems . Amino acid deficiency , including L-carnitine , has been proposed to be associated with its pathophysiology . Nevertheless , the efficacy of L-carnitine supplementation on frailty status has not been documented . Thus , this study aim ed to determine the effect of 10-week L-carnitine supplement ( 1.5 g/day ) on frailty status and its biomarkers and also physical function , cognition , and nutritional status among prefrail older adults in Klang Valley , Malaysia . Methodology This study is a r and omized , double-blind , placebo-controlled clinical trial conducted among 50 prefrail subjects r and omized into two groups ( 26 in L-carnitine group and 24 in placebo group ) . Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit , selected frailty biomarkers ( interleukin-6 , tumor necrosis factor-alpha , and insulin-like growth factor-1 ) , physical function , cognitive function , nutritional status and biochemical profile . Results The results indicated that the mean scores of Frailty Index score and h and grip test were significantly improved in subjects supplemented with L-carnitine ( P<0.05 for both parameters ) as compared to no change in the placebo group . Based on Fried criteria , four subjects ( three from the L-carnitine group and one from the control group ) transited from prefrail status to robust after the intervention . Conclusion L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults Bicarbonate supplementation preserves renal function in experimental chronic kidney disease ( CKD ) , but whether the same benefit occurs in humans is unknown . Here , we r and omly assigned 134 adult patients with CKD ( creatinine clearance [ CrCl ] 15 to 30 ml/min per 1.73 m(2 ) ) and serum bicarbonate 16 to 20 mmol/L to either supplementation with oral sodium bicarbonate or st and ard care for 2 yr . The primary end points were rate of CrCl decline , the proportion of patients with rapid decline of CrCl ( > 3 ml/min per 1.73 m(2)/yr ) , and ESRD ( CrCl < 10 ml/min ) . Secondary end points were dietary protein intake , normalized protein nitrogen appearance , serum albumin , and mid-arm muscle circumference . Compared with the control group , decline in CrCl was slower with bicarbonate supplementation ( 5.93 versus 1.88 ml/min 1.73 m(2 ) ; P < 0.0001 ) . Patients supplemented with bicarbonate were significantly less likely to experience rapid progression ( 9 versus 45 % ; relative risk 0.15 ; 95 % confidence interval 0.06 to 0.40 ; P < 0.0001 ) . Similarly , fewer patients supplemented with bicarbonate developed ESRD ( 6.5 versus 33 % ; relative risk 0.13 ; 95 % confidence interval 0.04 to 0.40 ; P < 0.001 ) . Nutritional parameters improved significantly with bicarbonate supplementation , which was well tolerated . This study demonstrates that bicarbonate supplementation slows the rate of progression of renal failure to ESRD and improves nutritional status among patients with CKD Cardiovascular disease is more common in patients with chronic kidney disease ( CKD ) , and traditional risk factors do not adequately predict those at risk for cardiovascular ( CV ) events . Recent evidence suggests elevated  trimethylamine N-oxide ( TMAO )  , created by gut microflora from dietary L-carnitine and choline , is associated with CV events . We investigated the relationship of TMAO levels in patients with stages 3b and 4 CKD to ischemic CV events using the CanPREDDICT cohort , a Canada-wide observational study with prospect i ve 3-year follow-up of adjudicated CV events . Baseline sample s were obtained for 2529 CKD patients .  TMAO , choline , and L-carnitine levels  were measured using t and em mass spectrometry . Baseline median TMAO level was high for the whole cohort ( 20.41 μM ; interquartile range [ IQR ] : 12.82 - 32.70 μM ) . TMAO was independently associated with CV events ( hazard ratio 1.23 ; 95 % confidence interval : 1.06 - 1.42 / 1 SD lnTMAO ) after adjusting for all potential CV risk factors . Those in the highest TMAO quartile had significantly higher risk of CV events ( adjusted hazard ratio 1.59 ; 95 % confidence interval : 1.04 - 2.43 ; P = 0.0351 ) in the analysis of recurring ischemic events . Among those with stage 3b CKD ( hazard ratio 1.45 ; 95 % confidence interval : 1.12 - 1.87 / 1 SD lnTMAO ) , independent of kidney function , TMAO levels identified those at highest risk for events . Our results suggest that TMAO may represent a new potentially modifiable CV risk factor for CKD patients . Further studies are needed to determine sources of variability and if lowering of TMAO reduces CV risk in CKD End-stage renal disease affects every aspect of a patient 's life , including perception of health and quality of life . It is likely that a hemodialysis patient 's perceptions of health-related quality of life directly influence compliance with medical , nursing , and nutritional prescriptions . Because L-carnitine supplementation is known to enhance muscle strength and energy in hemodialysis patients , we hypothesized that L-carnitine supplementation would enhance a hemodialysis patient 's perception of health-related quality of life . To test this hypothesis , 1 g L-carnitine or placebo was administered orally to 101 patients immediately before and after every hemodialysis treatment for 6 months . To assess health-related quality of life from the patient 's perspective , the Medical Outcomes Study Short Form 36 instrument was administered before the study and at 1.5-month intervals for the duration of the study . In addition , a 10-item question naire design ed to assess common intradialytic symptoms was administered at the end of each dialysis treatment . Other parameters analyzed included Kt/V(urea ) and level of nutrition . In the 6-month group , oral L-carnitine supplementation had an early positive effect on general health ( P < 0.02 ) and physical function ( P < 0.03 ) , but the perceived effect was not sustained throughout the 6 months of the study . In the 3-month group , L-carnitine supplementation improved vitality ( P < 0.02 ) and general health ( P < 0.01 ) . There was no association between Kt/V(urea ) and perceived health-related quality of life . Serum albumin concentration was directly correlated to how patients perceived the quality of their lives Objective : To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids ( VLPD+KA ) in comparison with a conventional low-protein diet ( LPD ) in chronic kidney disease ( CKD ) patients . Design : Prospect i ve , r and omized , controlled clinical study . Setting : Outpatient Clinic of the Nephrology Division of Federal University of São Paulo , Brazil . Subjects : The study involved 24 patients with advanced CKD ( creatinine clearance < 25 ml/min ) that were r and omly assigned to either a VLPD+KA ( VLPD+KA group , 12 patients ) or to a conventional LPD with 0.6 g/kg/day ( LPD group , 12 patients ) . The patients were followed for 4 months . Results : Nutritional status was adequately maintained with both diets for the studied period . Protein intake and serum urea nitrogen decreased significantly only in the VLPD+KA group ( from 0.68±0.17 to 0.43±0.12 g/kg/day , P<0.05 ; from 61.4±12.8 to 43.6±14.9 mg/dl , P<0.001 ; respectively ) . Ionized calcium did not change in the VLPD+KA group but tended to decrease in the LPD group . Serum phosphorus tended to decrease in the VLPD+KA group probably as a result of a significant reduction in dietary phosphorus ( 529±109 to 373±125 mg/day , P<0.05 ) associated to the phosphorus-binding effect of the ketoacids . No change in these parameters was found in the LPD group . Serum parathormone increased significantly only in the LPD group ( from 241±138 to 494±390 pg/ml , P<0.01 ) . The change in PTH concentration was negatively correlated with changes in ionized calcium concentration ( r=−0.75 , P=0.02 ) and positively correlated with changes in serum phosphorus ( r=0.71 , P=0.03 ) only in the LPD group . Conclusion : This study indicates that a VLPD+KA can maintain the nutritional status of the patients similarly to a conventional LPD . Besides , an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD+KA . Thus , VLPD+KA can constitute another efficient therapeutic alternative in the treatment of CKD patients .Sponsorship : This study was supported by CAPES , Oswaldo Ramos Foundation and Fresenius Kabi , Ltda To investigate whether L-carnitine supplementation may correct nutritional carnitine deficiency and associated metabolic disturbances in premature infants receiving total parenteral nutrition , an intravenous fat tolerance test ( 1 gm/kg Intralipid over four hours ) was performed in 29 premature infants 6 to 10 days of age ( 15 receiving carnitine supplement 10 mg/kg . day L-carnitine IV , and 14 receiving no supplement ) .  Total carnitine plasma values were normal or slightly elevated in supplemented but decreased in nonsupplemented infants . In both groups , fat infusion result ed in an increase in plasma concentrations of triglycerides , free fatty acids , D-beta-hydroxybutyrate , and short-chain and long-chain acylcarnitine , but total carnitine values did not change . After fat infusion , the free fatty acids/D-beta-hydroxybutyrate ratios were lower and the increase of acylcarnitine greater in supplemented infants of 29 to 33 weeks ' gestation than in nonsupplemented infants of the same gestational age . This study provides evidence that premature infants of less than 34 weeks ' gestation requiring total parenteral nutrition develop nutritional carnitine deficiency with impaired fatty acid oxidation and ketogenesis .  Carnitine supplementation improves this metabolic disturbance OBJECTIVE We assessed the effect of a severe hypoproteic diet supplemented with ketoanalogues ( SVLPD ) for 48 weeks on certain metabolic disorders of chronic kidney disease ( CKD ) . DESIGN We performed a prospect i ve , open-label , parallel , r and omized , controlled trial . SETTING The study took place in the Nephrology Department at the Dr Carol Davila Teaching Hospital of Nephrology , Bucharest , Romania . PATIENTS A total of 53 nondiabetic patients with CKD with an estimated glomerular filtration rate less than 30 mL/min/1.73 m(2 ) ( Modification of Diet in Renal Disease formula ) , proteinuria less than 1 g/g urinary creatinine , good nutritional status , and anticipated good compliance with the diet were r and omly assigned to two groups . INTERVENTION Group I ( n = 27 ) received the SVLPD ( 0.3 g/kg/d of vegetable proteins and ketoanalogues , 1 capsule for every 5 kg of ideal body weight per day ) . Group II ( n = 26 ) continued a conventional low mixed protein diet ( 0.6 g/kg/d ) . OUTCOME MEASURES Nitrogen waste products retention and calcium-phosphorus and acid-base disturbances were primary efficacy parameters , and " death " of the kidney or the patient and the estimated glomerular filtration rate were secondary efficacy parameters . The nutritional status and compliance with the diet were predefined as safety variables . There were no differences between groups in any parameter at baseline . RESULTS In the SVLPD group , serum urea significantly decreased ( 56 + /- 7.9 mmol/L vs. 43.2 + /- 10 mmol/L ) , and significant improvements in serum bicarbonate ( 23.4 + /- 2.1 mmol/L vs. 18.1 + /- 1.5 mmol/L ) , serum calcium ( 1.10 + /- 0.17 mmol/L vs. 1.00 + /- 0.15 mmol/L at baseline ) , serum phosphates ( 1.45 + /- 0.66 mmol/L vs. 1.91 + /- 0.68 mmol/L ) , and calcium-phosphorus product ( 1.59 + /- 0.11 mmol(2)/L(2 ) vs. 1.91 + /- 0.10 mmol(2)/L(2 ) ) were noted after 48 weeks . No death was registered in any group . Significantly lower percentages of patients in group I required renal replacement therapy initiation ( 4 % vs. 27 % ) . After 48 weeks , estimated glomerular filtration rate did not significantly change in patients receiving SVLPD ( 0.26 + /- 0.08 mL/s vs. 0.31 + /- 0.08 mL/s at baseline ) , but significantly decreased in controls ( 0.22 + /- 0.09 mL/s vs. 0.30 + /- 0.07 mL/s ) . The compliance with the keto-diet was good in enrolled patients . No significant changes in any of the parameters of the nutritional status and no adverse reactions were noted . CONCLUSION SVLPD seems to ameliorate the nitrogen waste products retention and acid-base and calcium-phosphorus metabolism disturbances and to postpone the renal replacement therapy initiation , preserving the nutritional status in patients with CKD BACKGROUND Systemic inflammation and protein-energy malnutrition may be associated with poor outcomes in kidney disease . METHODS We studied 26 adults ( age , 65 + /- 10 [ SD ] years ) with chronic kidney disease , not on dialysis therapy . Subjects were r and omly assigned to resistance training ( n = 14 ) or a control group ( n = 12 ) for 12 weeks , while counseled to consume a low-protein diet ( protein , approximately 0.6 g/kg/d ) . We determined whether resistance training reduces levels of inflammatory mediators ( serum C-reactive protein [ CRP ] and interleukin-6 [ IL-6 ] ) , in addition to previously reported improvements in nutritional and functional status in this same subject population . RESULTS Serum CRP levels were reduced in subjects undergoing resistance training ( -1.7 mg/L ) compared with controls ( 1.5 mg/L ; P = 0.05 ) . Similarly , IL-6 levels were reduced in the resistance-exercise group versus controls ( -4.2 versus 2.3 pg/mL ; P = 0.01 ) . Resistance training lead to skeletal muscle hypertrophy , shown by increases in type I ( 24 % + /- 31 % ) and type II ( 22 % + /- 41 % ) muscle fiber cross-sectional areas , compared with control subjects ( -14 % + /- 34 % and -13 % + /- 18 % , respectively ; P < 0.05 ) . Muscle strength also improved with resistance training ( 28 % + /- 14 % ) compared with controls ( -13 % + /- 22 % ; P = 0.001 ) . CONCLUSION Resistance training reduced inflammation and improved nutritional status in individuals with moderate chronic kidney disease consuming a low-protein diet . These results need to be investigated further in larger cohorts of patients with varying stages of kidney disease to determine whether resistance training can improve disease outcomes long term The present study was design ed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients ( n = 501 ) . The patients were r and omised into an experimental group which received nutritional supplementation ( 400 kcal ) as well as a st and ard hospital diet , and a control group on hospital diet alone . The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry , serum protein analysis and a delayed hypersensitivity skin test . Protein energy malnutrition was defined as the presence of three or more abnormal parameters . 28.5 % of patients showed evidence of malnutrition on admission . Hospitalisation itself result ed in a gradual deterioration in nutritional status .  Nutritional supplementation generally improved nutritional state . Among those patients who were well nourished on admission , and subsequently receiving dietary supplementation , 8.3 % fulfilled malnutrition criteria after 26 weeks , while 21.1 % were considered malnourished in the control group ( p < 0.05 ) . The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation . In the initially well nourished group of more than 300 patients , the mortality rate was 8.6 % in those given nutritional support compared to 18.6 % in the control group ( p < 0.02 ) Background Cachexia , a > 10 % loss of body-weight , is one factor determining the poor prognosis of pancreatic cancer . Deficiency of L-Carnitine has been proposed to cause cancer cachexia . Findings We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospect i ve , multi-centre , placebo-controlled , r and omized and double-blinded trial to receive oral L-Carnitine ( 4 g ) or placebo for 12 weeks . At entry patients reported a mean weight loss of 12 ± 2,5 ( SEM ) kg . During treatment body-mass-index increased by 3,4 ± 1,4 % under L-Carnitine and decreased ( −1,5 ± 1,4 % ) in controls ( p < 0,05 ) . Moreover , nutritional status ( body cell mass , body fat ) and quality -of-life parameters improved under L-Carnitine . There was a trend towards an increased overall survival in the L-Carnitine group ( median 519 ± 50 d versus 399 ± 43 d , not significant ) and towards a reduced hospital-stay ( 36 ± 4d versus 41 ± 9d , n.s . ) . Conclusion While these data are preliminary and need confirmation they indicate that patients with pancreatic cancer may have a clinical ly relevant benefit from the inexpensive and well tolerated oral supplementation of L-Carnitine Carnitine is essential for mitochondrial energy production . Disturbance in mitochondrial function may contribute to or cause the fatigue seen in Chronic Fatigue Syndrome ( CFS ) patients . Previous investigations have reported decreased carnitine levels in CFS . Orally administered L-carnitine is an effective medicine in treating the fatigue seen in a number of chronic neurologic diseases . Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients . Isolated reports suggest that it may also be effective in treating CFS patients . Formal investigations of the use of L-carnitine and amantadine for treating CFS have not been previously reported . We treated 30 CFS patients in a crossover design comparing L-carnitine and amantadine . Each medicine was given for 2 months , with a 2-week washout period between medicines . L-Carnitine or amantadine was alternately assigned as fist medicine . Amantadine was poorly tolerated by the CFS patients . Only 15 were able to complete 8 weeks of treatment , the others had to stop taking the medicine due to side effects . In those individuals who completed 8 weeks of treatment , there was no statistically significant difference in any of the clinical parameters that were followed . However , with L-carnitine we found statistically significant clinical improvement in 12 of the 18 studied parameters after 8 weeks of treatment . None of the clinical parameters showed any deterioration . The greatest improvement took place between 4 and 8 weeks of L-carnitine treatment . Only 1 patient was unable to complete 8 weeks of treatment due to diarrhea .  L-Carnitine is a safe and very well tolerated medicine which improves the clinical status of CFS patients . In this study we also analyzed clinical and laboratory correlates of CFS symptomatology and improvement parameters Abstract Chronic kidney disease ( CKD ) is characterized by a continuous reduction in kidney function , increased inflammation , and reduced antioxidant capacity . The objective of this study was to assess the effects of a herbal supplement on systemic inflammation and antioxidant status in non-dialysis CKD patients . Sixteen patients with CKD ( 56.0±16.0 yrs , 171.4±11.9 cm , 99.3±20.2 kg ) were r and omly chosen to receive a herbal supplement composed of Curcuma longa and Boswellia serrata , or placebo . Plasma levels of interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , glutathione peroxidase ( GPx ) , and serum C-reactive protein ( CRP ) were measured at baseline and 8 weeks . Baseline data demonstrated elevated inflammation and low antioxidant levels . A significant time effect ( p=0.03 ) and time x compliance interaction effect ( p=0.04 ) were observed for IL-6 . No significant differences were observed for any other variables . This study demonstrates that mild and moderate CKD is associated with chronic inflammation and low antioxidant activity . Systemic inflammation and impaired antioxidant status may be greater in CKD population s with multiple comorbidities . Curcumin and Boswellia serrata are safe and tolerable and helped to improve the levels of an inflammatory cytokine In epidemiologic studies , high arsenic exposure has been associated with adverse kidney disease outcomes . We performed a systematic review of the epidemiologic evidence of the association between arsenic and various kidney disease outcomes . The search period was January 1966 through January 2014 . Twenty-five papers ( comprising 24 studies ) meeting the search criteria were identified and included in this review . In most studies , arsenic exposure was assessed by measurement of urine concentrations or with an ecological indicator . There was a generally positive association between arsenic and albuminuria and proteinuria outcomes . There was mixed evidence of an association between arsenic exposure and chronic kidney disease ( CKD ) , β-2-microglobulin ( β2MG ) , and N-acetyl-β-D-glucosaminidase ( NAG ) outcomes . There was evidence of a positive association between arsenic exposure and kidney disease mortality . Assessment of a small number of studies with three or more categories showed a clear dose-response association between arsenic and prevalent albuminuria and proteinuria , but not with CKD outcomes . Eight studies lacked adjustment for possible confounders , and two had small study population s. The evaluation of the causality of the association between arsenic exposure and kidney disease outcomes is limited by the small number of studies , lack of study quality , and limited prospect i ve evidence . Because of the high prevalence of arsenic exposure worldwide , there is a need for additional well- design ed epidemiologic and mechanistic studies of arsenic and kidney disease outcomes BACKGROUND & AIMS Carnitine may be considered conditionally essential in the neonatal population . The purpose of this study was to evaluate the effects of long-term carnitine supplementation on total carnitine status and morbidity in premature neonates . METHODS In this prospect i ve , r and omized , placebo-controlled , double-blinded study , premature neonates received carnitine supplementation ( 20mg/kg/day ) or placebo .  Plasma ( nmol/ml ) and red blood cell ( RBC ) ( nmol/mg hemoglobin ) total carnitine concentrations , 24-h nitrogen excretion , intake and weight , and respiratory , gastroesophageal , and infectious morbidity were assessed . RESULTS Twenty-nine neonates ( 13 placebo , 16 carnitine ; 27+/-2 weeks gestation ; 976+/-259 g birthweight ) were studied for up to 8 weeks . Plasma total carnitine concentrations exceeded the reference range in the carnitine group ( weeks 1 - 8 ) ; however , concentrations did not reach reference range until week 4 in the placebo group . RBC total carnitine concentrations increased , but remained below reference range in both the carnitine ( weeks 1 - 6 ) and placebo ( weeks 1 - 8 ) groups . Carnitine group neonates regained their birthweight more rapidly than placebo group neonates ( day of life 11.8+/-6 vs. 16.9+/-6.3 , P=0.034 ) . In addition , percent periodic breathing calculated from cardiopulmonary trend monitor data ( weeks 1 - 8 ) was lower in the carnitine group ( 0.4+/-0.9 vs. 1.4+/-1.9 , P=0.014 ) . There was no difference with respect to other markers of respiratory , gastroesophageal and infectious morbidity or nitrogen balance . CONCLUSIONS Carnitine supplementation at 20mg/kg/day results in increased plasma and RBC total carnitine concentrations , has a positive effect on catch-up growth , and may improve periodic breathing in premature neonates The effects of carnitine supplementation on fat and glucose metabolism and carnitine balance were studied in 12 preterm neonates receiving full or partial parenteral nutrition ( PN ) for 5 to 21 days . The gestational age ranged from 27 to 32 weeks and the birth weight from 790 to 2090 g. The neonates were assigned at r and om to receive either L‐carnitine 10 mg/kg ( n=6 ) or saline ( n=6 ) . In the carnitine group , increased concentrations in plasma of total and free carnitine were observed . Less than 50 % of the given dose was recovered in urine . In the placebo group no changes in the total plasma carnitine concentration were seen . In all neonates plasma triglycerides , free fatty acids , glycerol , alanine , 3‐hydroxybutyrate ( BOB ) , glucose and lactate were measured at predetermined intervals . The only significant difference between the groups was higher BOB‐concentrations in the carnitine group 2 days after the start of parenteral nutrition . Elevated BOB concentrations are an indicator of improved fatty acid oxidation in the carnitine group . In this study , only a temporary effect of the carnitine supplementation was found Components present in the diet , l-carnitine , choline , and betaine are metabolized by gut microbiota to produce metabolites such as trimethylamine-N-oxide ( TMAO ) that appear to promote cardiovascular disease in chronic kidney disease ( CKD ) patients . The objective of this pilot study was to evaluate the effects of probiotic supplementation for 3 months on plasma TMAO levels in CKD patients on hemodialysis ( HD ) . A r and omized , double-blind trial was performed in 21 patients [ 54.8 ± 10.4 years , nine men , BMI 26.1 ± 4.8 kg/m2 , dialysis vintage 68.5 ( 34.2–120.7 ) months ] . Ten patients were r and omly allocated to the placebo group and 11 to the probiotic group [ three capsules , totaling 9 × 1013 colony-forming units per day of Streptococcus thermophilus ( KB19 ) , Lactobacillus acidophilus ( KB27 ) , and Bifidobacteria longum ( KB31 ) . Plasma TMAO , choline , and betaine levels were measured by LC-MS/MS at baseline and after 3 months . While TMAO did not change after probiotic supplementation , there was a significant increase in betaine plasma levels . In contrast , the placebo group showed a significant decrease in plasma choline levels . Short-term probiotic supplementation does not appear to influence plasma TMAO levels in HD patients . Long-term studies are needed to determine whether probiotics may affect TMAO production in CKD patients OBJECTIVE In end-stage renal disease ( ESRD ) patients , malnutrition is mainly addressed from a pharmacological but not educational point of view . Therefore , the objective of this study was to implement a nutritional education program ( NEP ) and to evaluate and compare its effectiveness in the treatment and prevention of malnutrition with oral supplementation (OS)-the st and ard treatment in these patients . DESIGN This study was a longitudinal , 4-month prospect i ve study . SETTING S The study was conducted from January to May 2012 in the Hemodialysis Fresenius Medical Care Clinic of Murcia . SUBJECTS One hundred twenty patients with ESRD undergoing hemodialysis were r and omly assigned to a NEP or to OS . INTERVENTION Patients assigned to the NEP group followed an educational program for 4 months that aim ed to improve general nutritional knowledge and included culinary recommendations and an elaboration of balanced menus . The OS group received a nutritional supplement during the hemodialysis procedure . MAIN OUTCOME MEASURE The main outcome measure was certain biochemical markers of nutritional and metabolic status . Nutrition knowledge was also evaluated . RESULTS After 4 months of intervention , nutritional knowledge was increased in all patients ( P < .050 ) after the NEP , which was reflected in a decrease in the prevalence of malnutrition , especially in this group . Creatinine clearance , total protein serum values , and other biochemical parameters improved significantly in both groups ( P < .050 in all cases ) , although other parameters such as C-reactive protein were impaired only in the NEP group . CONCLUSION The NEP was at least as effective as OS for preventing and even treating malnutrition in patients with chronic renal failure on hemodialysis , improving their nutritional status , which may result in a long-term decrease in the mortality and morbidity of these patients BACKGROUND & OBJECTIVE In protein-energy malnutrition ( PEM ) there is a significant impairment of immunity , both cell-mediated and humoral , which may be reversed with nutritional rehabilitation . With the use of probiotics like curd ( dahi ) and micronutrient-rich leaf protein concentrate ( LPC ) , this immune recovery may be hastened . This study was conducted to assess the impact of supplementation of curd and LPC on nutritional status , and immunity as assessed by anthropometry , haemoglobin , ferritin levels , T- cell sub population and C-reactive protein ( CRP ) , in children suffering from PEM . METHODS Eighty moderate to severely malnourished children ( 1 - 5 yr ) were r and omized to receive either curd or LPC in addition to WHO recommended two-step diet over 15 days . Nutritional , immunological and haematological parameters were measured before and after supplementation and compared within the groups . RESULTS The change in weight , haemoglobin level and CD4:CD8 T-cell sub population was significant in both the groups after supplementation . Response of CRP was blunted in PEM . Serum ferritin decreased significantly after supplementation in both groups . INTERPRETATION & CONCLUSION Curd and LPC when added to diet of malnourished children , may have therapeutic value by accelerating immune recovery . More studies need to be done on a larger sample to confirm these findings AIM Obesity is an important worldwide public health problem and considered a disease of chronic low- grade inflammation . The aim of this study was to evaluate the effect of L-carnitine supplementation in comparison with moderate aerobic exercise training on serum inflammatory parameters in healthy obese women . METHODS In this double-blind r and omized controlled clinical trial , 44 obese women were r and omly assigned to 4 groups ( N.=11 ) as follows : 1 : L-carnitine supplementation ( 2 g/day ) ( CAR ) , 2 : aerobic training + placebo ( EXR+PLA ) , 3 : L-carnitine supplementation + aerobic training ( CAR+EXR ) and 4 : placebo ( PLA ) . All intervention periods were eight weeks and subjects of aerobic training groups underwent 8-week aerobic training protocol ( 3 sessions a week [ 24 sessions ] ) . Body Mass Index , daily dietary intake and serum free L-carnitine , IL-6 , high-sensitivity C-reactive protein ( Hs-CRP ) and IL-10 levels of subjects were measured before and after interventions . RESULTS Interventions had no significant effects on body weight , BMI , daily dietary intake and serum IL-10 levels of subjects in all groups . Serum free L-carnitine concentration increased significantly after interventions in CAR and CAR+EXR groups . Significant decreases of IL-6 were observed in EXR+PLA and CAR+EXR groups compared with placebo group . L-carnitine supplementation plus aerobic training led to significant decrease of serum Hs-CRP levels in CAR+EXR group compared with baseline values . CONCLUSION L-carnitine supplementation did not affect serum IL-6 , Hs-CRP and IL-10 levels in obese women .  Aerobic training alone or in combination with L-carnitine had favorable effect on serum Il-6 and Hs-CRP levels as markers of inflammation in studied subjects Parenterally fed preterm neonates are known to be at risk for carnitine deficiency . We studied substrate utilization in low-birth-weight infants receiving total parenteral nutrition ( TPN ) with ( A ) and without ( B ) supplementation of 48 mg carnitine.kg-1.d-1 on days 4 - 7 ( birth weights 1334 + /- 282 vs 1318 + /- 248 g , gestational age 32 + /- 2 vs 32 + /- 2 wk , A vs B , respectively ) . TPN consisted of 11 g glucose.kg-1.d-1 and 2.4 g.kg-1.d-1 of both protein and fat . Plasma carnitine concentrations at day 7 were for free carnitine 11.8 + /- 5.0 vs 164 + /- 56 mumol/L and for acyl carnitine 3.8 + /- 2.0 vs 33.9 + /- 15.4 mumol/L , respectively . Indirect calorimetry at day 7 showed a higher fat oxidation ( 0.21 , -0.31 to + 0.60 vs 1.18 , 0.70 to 1.95 g. kg-1.d-1 , respectively , P less than 0.02 , median and interquartile range ) in group B and a higher protein oxidation ( 0.37 , 0.30 - 0.43 vs 0.63 , 0.53 - 0.88 g.kg-1.d-1 , P less than 0.001 ) . The time to regain birth weight was also higher in group B ( 7 , 5.5 - 9 vs 9 , 7 - 14 d , P less than 0.05 ) . Carnitine supplementation and calorie intake were the best explanatory variables for metabolic rate ( R2 = 0.45 , P less than 0.002 ) . We conclude that carnitine supplementation of TPN in this dosage does not seem advisable
Having this evidence s , the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined
Protein energy malnutrition is a common problem in patients with chronic kidney disease ( CKD ) .
Scattered reports indicate that supplementation of Carnitine may improve patients ' clinical symptoms , with significant improvement in nutritional parameters .
This systematic review was done to document the evidence s of Carnitine effects in nutritional status of CKD patients .