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Abstract: SA-PO703

Determinants of Carnitine and Acetylcarnitine in Peritoneal Dialysis Patients: Results from PD-CRAFT

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Lambie, Mark, Keele University, Crewe, United Kingdom
  • Davies, Simon J., Keele University, Crewe, United Kingdom
Background

In haemodialysis (HD) patients carnitine metabolism plays an important role in lipid metabolism and oleoylcarnitine levels independently predicted death. The role of carnitine in peritoneal dialysis patients is less clear.

Methods

PD-CRAFT is a cross-sectional observational study of 1349 UK prevalent PD patients. A substudy of 961 patients included blood samples taken at the time of data collection assayed for carnitine (C0) and acetylcarnitine (C2) levels with mass spectroscopy. Linear mixed modelling accounting for clustering by centre with backwards variable selection was used in multivariable modelling of log-transformed C0 and square root transformed C2 levels.

Results

The population was representative of the UK PD population (mean age 59.2 years, 65% male, 27% diabetic and median duration of PD 9 months). C0 and C2 had median levels of 23.7 (IQR 26.4-32.1) and 15.5 (IQR 9.7-22.5) respectively. Higher C0 levels were associated with male gender (0.17, 95%CI 0.04, 0.31), lower LDL-cholesterol (-0.07, 95%CI -0.12, -0.01) and not using Icodextrin (0.23, 95%CI 0.09, 0.37). Higher C2 levels were associated with male gender (0.19, 95%CI 0.005, 0.38), lower plasma albumin levels (-0.030, 95%CI -0.049, -0.011), higher BMI (0.030, 95%CI 0.014, 0.047), use of APD (0.22, 95%CI 0.02, 0.42) and not using Icodextrin (0.31, 95%CI 0.10, 0.51). The associations with Icodextrin and use of APD persisted when adjusted for dialysate glucose load and peritoneal solute transport.

Conclusion

Higher carnitine levels were associated with reductions in LDL-cholesterol in PD patients. The gender difference in carnitine levels described previously in the general population persists in PD. The association between C2 and use of APD replicates a previous smaller study, whilst the consistent and robust association between both C0/C2 and Icodextrin could reflect either a direct effect or indirect via reduced dialysate glucose loading over a prolonged period.