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Abstract: SA-PO797

Association between Resistance to Erythropoiesis-Stimulating Agents and Carnitine Profile in Patients on Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Kamei, Daigo, Tokyo Women's University, Tokyo, Japan
  • Tsuchiya, Ken, Tokyo Women's Medical University, Shinjuku-ku, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Shinjuku-ku, Japan

Patients on dialysis are in a chronic carnitine-deficient state. This condition may be associated with abnormalities in fatty acid and organic acid metabolism; however, the details are unknown. We investigated the association between carnitine profiles before and after dialysis and the erythropoiesis-stimulating agent (ESA) resistance index (ERI), which is a significant prognostic factor in patients on maintenance hemodialysis.


cross-sectional study. We measured the carnitine profile of 79 patients on maintenance hemodialysis before and after dialysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The associations between the ERI and pre-dialysis carnitine profile, removal rate of various carnitines, and previously-reported ERI-related factors were investigated. Significant factors were determined with stepwise multiple regression analysis and validated with the bootstrap method. SPSS version 22.0 was used for analysis, and P<0.05 was considered statistically significant.


The removal rate of long-chain acylcarnitine with dialysis was lower than that of short-chain or medium-chain acylcarnitines. Stepwise multiple regression analysis (n=79) demonstrated that 3-hydroxy isovalerylcarnitine (C5-OH, P<0.001, β= -0.469) and stearoylcarnitine (C18, P<0.001, β= 0.390) were independent significant factors (R2= 0.239) of ERI. The bootstrap method similarly indicated these two to be significant factors.


ERI was positively correlated with long-chain C18 acylcarnitine and was negatively correlated with short-chain C5-OH acylcarnitine. C5-OH and C18 acylcarnitines at baseline might be contributing factors in distinguishing responders from nonresponders after L-carnitine administration.