Abstract: FR-PO0744
Secondary Carnitine Deficiency and Supplementation: Prevalence of High-Risk Children Receiving Maintenance Hemodialysis
Session Information
- Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Vega, Molly RW, Baylor College of Medicine, Houston, Texas, United States
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Brokenshire, Samantha, Texas Children's Hospital, Houston, Texas, United States
- Geer, Jessica, Baylor College of Medicine, Houston, Texas, United States
- Silos, Christin N., Baylor College of Medicine, Houston, Texas, United States
- Juarez, Marisa D., Texas Children's Hospital, Houston, Texas, United States
- Nadeem, Saad, Texas A&M University System, College Station, Texas, United States
- Swartz, Sarah J., Baylor College of Medicine, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
- Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
Background
Carnitine facilitates beta-oxidation and energy production. Secondary carnitine deficiency (CD) results from reduced enteral protein intake or absorption, diminished muscle mass, impaired synthesis, or increased losses via hemodialysis (HD). CD may manifest as poor growth, erythropoiesis-stimulating agent (ESA) hyporesponsiveness, dyslipidemia, myopathy, and intradialytic complications. CD is understudied in pediatric HD. We implemented screening parameters and intravenous (IV) supplementation protocols for high-risk patients, and aimed to describe screening practices, CD prevalence, and associations with clinical parameters. Screening criteria included: malnutrition (BMI z-score <-1, unexplained weight loss, or nPCR <1.0), intradialytic hypotension (defined per Pediatric Advanced Life Support, PALS), ESA hyporesponsiveness, or HD frequency >3×/week.
Methods
Among 171 children receiving chronic outpatient HD (May 2019-May 2024), 92 (54%) patients underwent carnitine testing. CD was defined as free carnitine <20 nmol/mL, total <40 nmol/mL, or acyl:free ratio >0.4.
Results
Median carnitine levels were: total 90 (IQR 48-153) nmol/mL, free 55.5 (28-87) nmol/mL, and acyl 31.5 (14-63) nmol/mL carnitine in 92 patients (52% male, 11.1 ±5.9yrs). 58% of tested patients met biochemical criteria for CD. Those with intradialytic hypotension (IDH) between measurements had 1.73-fold higher odds of CD (95% CI: 1.46–2.11, p<0.001). Median IV levocarnitine supplementation dose was 30.43 (0-84.73) mg/kg/month overall, and was appropriately higher (58.85 (37.74-111.54) mg/kg/month) in CD patients. Higher nPCR levels corresponded to lower odds of CD (92% reduction per unit, 95% CI [0.01–0.74], p=0.04) in non-IDPN (intradialytic parenteral nutrition) patients versus IDPN recipients (OR=0.10, 95% CI: 0.00–3.34, p=0.29). Weak triglyceride (r=0.158, p=0.0037) association and no BMI z-score (p=0.1123) correlations to CD.
Conclusion
CD was common (58%) in tested high-risk HD patients and significantly associated with IDH. NPCR levels and IDPN use modified deficiency risk. Further analysis of symptom resolution and anemia management is ongoing. Targeted screening may optimize management of at-risk children. Future efforts should address barriers to testing.