Clinical Investigation

Kidney International (1992) 41, 1613–1619; doi:10.1038/ki.1992.233

Carnitine metabolism during exercise in patients on chronic hemodialysis

William R Hiatt, Brian J Koziol1, Joseph I Shapiro and Eric P Brass

Department of Medicine, Section of Vascular Medicine, and Division of Renal Medicine, University of Colorado School of Medicine, Denver, Colorado; McGaw Inc, Irvine, California; Departments of Medicine and Pharmacology,case Western Reserve University, Cleveland, Ohio, USA

Correspondence: William R Hiatt MD, Section of Vascular Medicine, University of Colorado School of Medicine, 4200 E. Ninth Ave., Box B-180, Denver, Colorado80262, USA.

1The current address of Dr. Koziol is Oxford Research International, Corp., 5959 West Century Boulevard, Suite #510, Los Angeles, CA 90045.

Received 17 May 1991; Revised 3 January 1992; Accepted 6 January 1992.

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Abstract

Carnitine metabolism during exercise in patients on chronic hemodialysis. Patients on hemodialysis (HD) have impaired exercise performance. Carnitine homeostasis is also abnormal in this population. As carnitine is an important cofactor for muscle energy metabolism, exercise performance and skeletal muscle carnitine metabolism were characterized in eight HD patients, and in five age-matched controls. Each patient underwent graded bicycle exercise testing to define maximal performance, and prolonged exercise at 70% of their peak work capacity. Muscle (vastus lateralis) total carnitine content (carnitine plus all acylcarnitines) at rest was lower in HD patients than in controls (2320 plusminus 1190 vs. 3800 plusminus 940 nmol/g, P < 0.05). In patients on HD, muscle carnitine content was inversely correlated to time on HD (r = -0.74, P < 0.05), and positively correlated to peak exercise performance (r = 0.77, P < 0.05). In patients on HD, 8 plusminus 7% of the muscle carnitine pool at rest was short-chain acylcarnitines (similar to the distribution in controls), but 32 plusminus 5% of the plasma carnitine pool consisted of short-chain acylcarnitines. With high-intensity exercise in patients on HD, muscle short-chain acylcarnitine content increased from 130 plusminus 130 to 1380 plusminus 820 nmol/g (P < 0.01). The change in muscle short-chain acylcarnitine content with exercise was correlated with the increase in muscle lactate content (r = 0.88, P < 0.01). In summary, patients on HD had a lower muscle total carnitine content than control subjects which was correlated to exercise performance. In the HD patients during exercise, the load-dependent changes in muscle metabolism (lactate accumulation, acylcarnitine production) occurred over a constricted range of work loads, but were qualitatively similar to the responses observed in normal subjects.

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