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

Abstract Leg 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 bindin...

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Autor principal:	Akira Takahashi
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	acyl coenzyme A ATP carnitine coenzyme Q10 contraction alkalosis leg cramping Physiology QP1-981
Acceso en línea:	https://doaj.org/article/e0271a8d72ce41f3badaaeb42fae2c30
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spelling	oai:doaj.org-article:e0271a8d72ce41f3badaaeb42fae2c302021-11-15T09:54:41ZThe pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment2051-817X10.14814/phy2.15114https://doaj.org/article/e0271a8d72ce41f3badaaeb42fae2c302021-11-01T00:00:00Zhttps://doi.org/10.14814/phy2.15114https://doaj.org/toc/2051-817XAbstract Leg 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 example, β‐oxidation and the tricarboxylic acid cycle may be affected by a deficiency of water‐soluble vitamins and the electron transport chain requires coenzyme Q10, but statins inhibit its production. The resulting accumulation of excess long‐chain acyl‐CoA in mitochondria inhibits enzymes involved in energy production. Thus, carnitine administration may be used more effectively if clinicians are aware of its specific physiologic roles.Akira TakahashiWileyarticleacyl coenzyme AATPcarnitinecoenzyme Q10contraction alkalosisleg crampingPhysiologyQP1-981ENPhysiological Reports, Vol 9, Iss 21, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acyl coenzyme A ATP carnitine coenzyme Q10 contraction alkalosis leg cramping Physiology QP1-981
spellingShingle	acyl coenzyme A ATP carnitine coenzyme Q10 contraction alkalosis leg cramping Physiology QP1-981 Akira Takahashi The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
description	Abstract Leg 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 example, β‐oxidation and the tricarboxylic acid cycle may be affected by a deficiency of water‐soluble vitamins and the electron transport chain requires coenzyme Q10, but statins inhibit its production. The resulting accumulation of excess long‐chain acyl‐CoA in mitochondria inhibits enzymes involved in energy production. Thus, carnitine administration may be used more effectively if clinicians are aware of its specific physiologic roles.
format	article
author	Akira Takahashi
author_facet	Akira Takahashi
author_sort	Akira Takahashi
title	The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
title_short	The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
title_full	The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
title_fullStr	The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
title_full_unstemmed	The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
title_sort	pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/e0271a8d72ce41f3badaaeb42fae2c30
work_keys_str_mv	AT akiratakahashi thepathophysiologyoflegcrampingduringdialysisandtheuseofcarnitineinitstreatment AT akiratakahashi pathophysiologyoflegcrampingduringdialysisandtheuseofcarnitineinitstreatment
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The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment

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