Exercise and Carnitine Supplementation for People with Chronic Kidney Disease Who are Subjected to Dialysis

Abstract

The exercise previously does not consist for hemodialysis patients with chronic renal failure as considered that they could not cope due to complications of the disease. However, recent studies show that physical activity brings a variety of positive responses, reducing morbidity and mortality and improving the quality and duration of life. Moreover, long term administration of L-carnitine, which is lost during dialysis, positively affects these factors but to a lesser extent. Thus, when combined, long-term exercise and administration of L-carnitine act synergistically. For the analysis of the implications, we conducted an extensive literature
review. The review’s results show that long-term cardiovascular exercise improves VO2peak and respiratory and vascular system, along with carnitine increases the hematocrit value and the number of mitochondria, thus enhancing oxidative phosphorylation agent PGC-1, and adjusts the acquired natural immunity influencing the complement system, secretion of chemokines and regulates pro-inflammatory cytokine expression levels restricting organ fibrosis, mean arterial pressure, the rate of osteolysis, falling of eGFR and the production of metabolic by-products. Moreover, appears to cause diverse cellular responses regarding the levels of expression of TGF-b, TGF-a, VEGF, BMPs and cytoplasmic molecules such as p38, NF-AT, NF-kB, AP-1, JNK, and others. Thus, boosts growth paths and means of survival induction of antioxidant enzymes genes, improves fatty acid profile, the body's ability regarding the homeostasis of glucose and acid-base balance indicators. Moreover, cardiovascular and resistance exercise is shown to increase the levels of additional hormones, activating osteoblasts and increasing the levels of phosphagens intramuscularly acting alkaline while promoting myosynthesis. L-Carnitine has some of the above properties and strengthens the ability to exercise until exhaustion as it reduces the need for erythropoietin. So, they act synergistically. In conclusion, it appears that the exercise and L-carnitine have many common actions but this of exercise is superior. Furthermore, the administration of carnitine can increase the acute exercise duration and their combination can enhance the positive effects of improving the clinical status of hemodialysis patients and increasing their lifespan, especially when erythropoietin is also administrated.