Condition
Renal Anemia
Renal anemia happens when damaged kidneys make too little erythropoietin, the hormone that tells bone marrow to build red blood cells, leaving people with low hemoglobin, fatigue and breathlessness. Iron has the strongest evidence among supplements, and in dialysis trials a once-monthly drug, peginesatide, kept hemoglobin as steady as epoetin over a year. The supplement research is thinner: a single study of 14 people found L-carnitine made no clear difference to hematocrit.
Sources: PMID 23343061; PMID 11114574
- Supplements studied
- 1
- Medicines and peptides
- 1
- Graded outcomes
- 5
- Trials
- 1
- People studied
- 14
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hematocrit No effect | NoneNo effect | 1 study | 14 people | |||
Studies that measured hematocrit | ||||||
| Total Iron Binding Capacity | Improves (the measure goes up) | 14 people | ||||
Prescription medicines and peptides studied, for context
Peginesatide (Omontys)
- Hemoglobin Maintenance (Dialysis)
- Cardiovascular Safety (Non-Dialysis): worsens
- Anaphylaxis Risk: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hemoglobin Maintenance (Dialysis) EMERALD 1+2 trials (n=1608): Once-monthly peginesatide noninferior to epoetin (1-3x weekly) for maintaining Hgb 10-12 g/dL over 52+ weeks. Similar mean Hgb levels. Similar transfusion requirements. Approved only for dialysis patients. | NoneNo effect | 8 studies | ||||
| Cardiovascular Safety (Non-Dialysis) SAFETY CONCERN - PEARL trials (n=1066 non-dialysis CKD): Cardiovascular events and mortality INCREASED with peginesatide vs darbepoetin. FDA declined approval for non-dialysis patients. Mechanism unclear - may relate to higher dose requirements. | Worsens (the measure goes down) | Moderate effect | 5 studies | |||
| Anaphylaxis Risk SAFETY CONCERN - DRUG WITHDRAWN: Post-marketing: 0.2% severe allergic reactions, 0.02% fatal anaphylaxis rate. 13 cases of serious hypersensitivity within 30 min of first dose reported. Voluntary worldwide recall February 2013 - 11 months after FDA approval. | Worsens (the measure goes up) | Moderate effect | ||||
| Pure Red Cell Aplasia Treatment Unique application: Effective in anti-EPO antibody-mediated pure red cell aplasia (PRCA) due to no structural homology to EPO. Could stimulate erythropoiesis in heavily transfusion-dependent PRCA patients who failed all recombinant EPO therapies. | Improves (the measure goes up) | Large effect |
Key findings
- Hematocrit
The Renal Anemia (Anemia of Chronic Kidney Disease) Supportive Care protocol
2 primary supplements · 6 supporting supplements
Studies cited
100 studies from PubMed
- Flow Microscopy Imaging Is Sensitive to Characteristics of Subvisible Particles in Peginesatide Formulations Associated With Severe Adverse Reactions.
- Investigating Serious Adverse Drug Reactions in Patients Receiving Erythropoiesis-Stimulating Agents: A Root Cause Analysis Using the "ANTICIPATE" Framework.
- Subvisible Particle Content, Formulation, and Dose of an Erythropoietin Peptide Mimetic Product Are Associated With Severe Adverse Postmarketing Events.
- Peginesatide to manage anemia in chronic kidney disease patients on peritoneal dialysis
- Relative safety of peginesatide and epoetin alfa.
- Peginesatide in patients with anemia undergoing hemodialysis
- Peginesatide for anemia in patients with chronic kidney disease not receiving dialysis
- Peginesatide for the treatment of renal disease-induced anemia
- Managing dialysis patients who develop anemia caused by chronic kidney disease: focus on peginesatide
- On peginesatide and anemia treatment in CKD
- Differentiating factors between erythropoiesis-stimulating agents: an update to selection for anaemia of chronic kidney disease.
- Anemia treatment in patients with chronic kidney disease.
- Peginesatide for anemia in chronic kidney disease.
- Anaemia: The safety and efficacy of peginesatide in patients with CKD.
- Dose-finding study of peginesatide for anemia correction in chronic kidney disease patients
- New blood-boosting drugs aim to staunch renal anemia.
- New strategies for managing anemia of chronic kidney disease.
- Peginesatide (Omontys) for anemia in chronic kidney failure.
- Profile of peginesatide and its potential for the treatment of anemia in adults with chronic kidney disease who are on dialysis.
- Peginesatide for the treatment of anemia in the nephrology setting.
- A review of safety, efficacy, and utilization of erythropoietin, darbepoetin, and peginesatide for patients with cancer or chronic kidney disease: a report from the Southern Network on Adverse Reactions (SONAR).
- Peginesatide: a potential erythropoiesis stimulating agent for the treatment of anemia of chronic renal failure
- Genotoxic assessment and toxicity evaluation of peginesatide in CByB6F1 hybrid mice.
- Chronic kidney disease-associated anemia: new remedies.
- L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled study
- L-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapy
- Comparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patients
- Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitus
- Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients
- Effects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients
- L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes
- Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus
- Effect of carnitine-orotate complex on glucose metabolism and fatty liver: a double-blind, placebo-controlled study
- Efficacy and tolerability of combined treatment with L-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus
- Blood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled Trial
- The effects of oral L-carnitine treatment on blood lipid metabolism and the body fat content in the diabetic patient
- The effect of L-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus
- The effects of L-carnitine supplementation on cardiovascular risk factors in participants with impaired glucose tolerance and diabetes: a systematic review and dose-response meta-analysis.
- Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial
- Effect of oral L-carnitine administration on insulin sensitivity and lipid profile in type 2 diabetes mellitus patients
- The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis.
- L-carnitine improves glucose disposal in type 2 diabetic patients
- Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism
- Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes
- Acetyl-l-carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study
- The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis
- Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.
- Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial
- Effects of Carnitine Administration on Carotid Intima-media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome: A Randomized, Double-blind, Placebo-controlled Trial
- Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis
- Effect of glycine propionyl-L-carnitine on aerobic and anaerobic exercise performance
- Influence of L-carnitine administration on maximal physical exercise
- Effects of nine weeks L-Carnitine supplementation on exercise performance, anaerobic power, and exercise-induced oxidative stress in resistance-trained males
- l-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and women
- Glycine propionyl-L-carnitine produces enhanced anaerobic work capacity with reduced lactate accumulation in resistance trained males
- Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans
- The effect of oral supplementation with L-carnitine on maximum and submaximum exercise capacity
- Effect of intravenous L-carnitine on carnitine homeostasis and fuel metabolism during exercise in humans
- Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort
- l-Carnitine Supplementation in Older Women. A Pilot Study on Aging Skeletal Muscle Mass and Function
- Effects of L-carnitine L-tartrate supplementation on muscle oxygenation responses to resistance exercise
- The effects of L-carnitine L-tartrate supplementation on hormonal responses to resistance exercise and recovery
- Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue
- Oxidative stress in response to aerobic and anaerobic power testing: influence of exercise training and carnitine supplementation
- Effect of L-carnitine on submaximal exercise metabolism after depletion of muscle glycogen
- Androgenic responses to resistance exercise: effects of feeding and L-carnitine
- Carbohydrate, protein, and fat metabolism during exercise after oral carnitine supplementation in humans
- Effects of four weeks L-carnitine L-tartrate ingestion on substrate utilization during prolonged exercise
- L -Carnitine and the recovery from exhaustive endurance exercise: a randomised, double-blind, placebo-controlled trial
- Effects of carnitine coingested caffeine on carnitine metabolism and endurance capacity in athletes
- Effects of L-carnitine supplementation on physical performance and energy metabolism of endurance-trained athletes: a double-blind crossover field study
- Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.
- L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study
- Effect of lysine, vitamin B(6), and carnitine supplementation on the lipid profile of male patients with hypertriglyceridemia: a 12-week, open-label, randomized, placebo-controlled trial
- L-carnitine infusion does not alleviate lipid-induced insulin resistance and metabolic inflexibility
- Effects of acute versus chronic L-carnitine L-tartrate supplementation on metabolic responses to steady state exercise in males and females
- Liver-Oriented Acute Metabolic Effects of A Low Dose of L-Carnitine under Fat-Mobilizing Conditions: Pilot Human Clinical Trial
- The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials
- The effect of L-carnitine on inflammatory mediators: a systematic review and meta-analysis of randomized clinical trials
- Single dose administration of L-carnitine improves antioxidant activities in healthy subjects
- Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men
- Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjects
- L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trial
- Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults
- The effect of l-carnitine on fat oxidation, protein turnover, and body composition in slightly overweight subjects
- Effects of exercise intensity and altered substrate availability on cardiovascular and metabolic responses to exercise after oral carnitine supplementation in athletes
- Safety measures of L-carnitine L-tartrate supplementation in healthy men
- Effects of oral L-carnitine supplementation on insulin sensitivity indices in response to glucose feeding in lean and overweight/obese males
- Glycine propionyl-L-carnitine increases plasma nitrate/nitrite in resistance trained men
- Effects of L-carnitine on oxidative stress responses in patients with renal disease
- Effects of L-carnitine supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.
- Effects of combined treatment with simvastatin and L-carnitine on triglyceride levels in diabetic patients with hyperlipidaemia
- Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery disease
- Effects of carnitine on thyroid hormone action
- L-carnitine improves the asthma control in children with moderate persistent asthma
- Carnitine supplementation improves metabolic flexibility and skeletal muscle acetylcarnitine formation in volunteers with impaired glucose tolerance: A randomised controlled trial
- The effects of L-carnitine supplementation on performance during interval swimming
- Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging
- Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy