The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment

A key component of the etiology of leg cramping during hemodialysis sessions is alkalosis, which induces hypocalcemia and the release of calcium ions from the sarcoplasmic reticulum. Alkalosis is caused by not only dialysate but also contraction alkalosis due to fluid loss. The ATP provided by the correct use of carnitine supplementation ensures the reabsorption of calcium into the sarcoplasmic reticulum, which rapidly stops the excessive muscle contractions (Figure 3). The routine use of carnitine in patients undergoing hemodialysis is now becoming established in Japan. AbstractLeg cramping is a common side effect of hemodialysis, and this is frequently treated by the administration of carnitine, but this is not effective in every patient. Alkalosis is a key component of the etiology of leg cramping during hemodialysis sessions. This is mediated through the binding of calcium ions to serum albumin, which causes hypocalcemia, and an increase in the release of calcium ions from the sarcoplasmic reticulum. Normally the calcium pump on the sarcoplasmic reticulum consumes ATP and quickly reuptakes the released calcium ions, which rapidly stops excessive muscle contractions. Thus, carnitine deficiency results in prolonged muscle contraction because of ATP depletion. However, during ATP production, carnitine is only involved up to the stage of acyl-CoA transport into mitochondria, and for the efficient generation of ATP, the subsequent metabolism of acyl-CoA is also important. For ...
Source: Physiological Reports - Category: Physiology Authors: Tags: REVIEW Source Type: research