Buradasınız

Anasayfa » Content

L-Karnitin Tedavisi Hemodiyaliz Hastalarında Rutin Olarak Kullanılmalı mı?

Should Carnitine Treatment Be Used for All Hemodialysis Patients?

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2010
DOI: 
10.5262/tndt.2010.1001.04

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Objective: Carnitine has been reported to improve anemia, to decrease erythropoietin requirement and to reduce intradialytic complications and muscle cramps. The aim of this study was to investigate the effects of L-carnitine treatment on erythropoietin requirement, anemia and other metabolic parameters with intradialytic hypotension and muscle cramps on chronic hemodialysis patients. MATERIAL and METHOD: The study included 28 patients (11F, mean age 41±16 years, mean dialysis time 15.6±16 months) on 3x4 hours of dialysis per week and not given prior carnitine supplementation. Subjects were enrolled in a prospective, cross-over and controlled manner. The patients were assigned into two groups (group 1 and 2) each having 14 patients. Groups were given 20mg/kg (iv) carnitine and placebo at the end of each dialysis session. Predialysis blood pressure, interdialytic weight gain, cardio-thoracic index (CTI), biochemical parameters, hematological parameters and erythropoietin requirements were recorded before and monthly during the study. Intradialytic hypotension, muscle cramps and permanent or temporary stopping of ultrafiltration were recorded during the study. Result s: Group1 (5F, mean age 41±15,6years, mean time on dialysis 18.7±17.5 months) and Group 2 (6F, mean age 41±17.6 years, mean time on dialysis 12.5±14.8 months) each consisted of 14 patients. There was no significant difference between the two groups for any parameter or erythropoietin requirement at the beginning of the study. Although Hb levels increased and erythropoietin requirement decreased in both groups, there was no significant difference between the groups for hematological parameters at the end of the 12th week (p=0.31, 0.52). At the end of 24th week, the Hb increased and erythropoietin requirement decreased in group1 while Hb decreased and erythropoietin requirement increased in group 2 but these differences were not significant between the groups (p=0.63,0.36). Intradialytic hypotension and muscle cramps were not significantly different between the groups, at the end of the 12th or 24th weeks (p=0.45, 0.86 and 0.12, 0.94 respectively). Conclusion: The results of this study show that the effects of carnitine treatment in regard to hematological parameters, erythropoietin requirement and intradialytic complications are not different from placebo. Widespread administration of carnitine is therefore not recommended to all hemodialysis patients.
Abstract (Original Language): 
GİRİŞ: Karnitinin anemi parametrelerini düzelttiği, eritropoetin ihtiyacında azalmaya ve kas krampları ile intradiyalitik komplikasyon sıklığında azalmaya neden olduğu bildirilmiştir. Kronik hemodiyaliz hastalarında karnitin tedavisinin hastaların eritropoetin ihtiyacı, anemi ve diğer metabolik parametreler ile intradiyalitik hipotansiyon, intradiyalitik kas krampları üzerine etkisinin olup olmadığının saptanması amaçlandı. GEREÇ ve YÖNTEM: Hemodiyaliz ünitemizde düzenli tedavi gören 28 hasta (11 kadın, yaş ortalaması 41±16,3 yıl) çalışmaya dahil edildi. Çalışma prospektif çapraz kontrollü olarak planlandı. 14’er hastadan oluşan iki grup (grup 1 ve grup 2) oluşturuldu. Gruplara 12’şer hafta süreyle 20 mg/kg (iv) dozunda L-Karnitin ve plasebo diyaliz sonunda verildi. On iki hafta sonunda plasebo verilen gruba L-karnitin, L-Karnitin verilen gruba ise plasebo verilmeye başlandı ve 24 hafta sonunda çalışma sonlandırıldı. Çalışma öncesi ve çalışma boyunca tüm hastaların kan basınçları, kilo alımları, biyokimyasal ve hematolojik parametreleri ve eritropoetin ihtiyaçları aylık olarak kaydedildi Çalışma süresince hastaların intradiyalitik hipotansiyon, kas krampı ve ultrafiltrasyonun geçici veya kalıcı olarak durdurulduğu seans sayıları saptandı. BULGULAR: Grup 1’deki 14 hasta (5K, ort.yaş. 41±15,6 yıl, ort. diyaliz süresi 18,7±17,5 ay), Grup 2’de ise 14 hastadan (6K, ort.yaş 41±17,6 yıl, ort. diyaliz süresi 12,5±14,8 ay) oluşmaktaydı. Çalışma başlangıcında her iki grup arasında bakılan tüm parametreler ve kullanılan eritropoetin dozları açısından anlamlı bir farklılık yoktu. 12 hafta sonunda her iki grupta da hemoglobin (hb) düzeyi artıp eritropoetin ihtiyacı azalmasına rağmen gruplar arasında hematolojik parametreleri açısından anlamlı farklılık saptanmadı (p=0,31ve 0,52). 24.hafta sonunda da grup 1’deki (plasebo verilen) hb artışı, eritropetin ihtiyacındaki azalma devam ederken, grup 2’de (karnitin verilen) ise hb azalması ve eritropoetin ihtiyacında artma saptandı, ancak gruplar arasındaki bu değişimler anlamlı bulunmadı (p=0,63 ve 0,36). İki grupta da hem 12. hem de 24. hafta sonunda intradiyalitik hipotansiyon ve kas krampı görülme sıklığı anlamlı bulunmadı (p=0,45, 0,86 ve 0,08, 0,94). SONUÇ: Bu çalışmanın, sonuçlarına göre karnitin tedavisinin hb, eritropoetin ihtiyacı gibi anemi parametrelerine ilaveten intradiyalitik komplikasyonlar açısından plaseboya üstünlüğü saptanmamıştır, Bu nedenle her hastaya yaygın kullanımın doğru olmayacağı sonucuna varılmıştır.
FULL TEXT (PDF): 
PDF icon arastrmx_172977_19_pp_29-34.pdf

REFERENCES

References: 

1. Ahmad S: L-carnitine in dialysis patients. Semin Dial 2001;
14:209–217
2. Böhmer T, Rydning A, Solberg HE: Carnitine levels in human
serum in health and disease. Clin Chim Acta 1974; 57: 55–61
3. Rodriguez-Segade S, del la Pena C, Paz M, Novoa D, Romero R,
Arcocha V, Del Rio R: Carnitine concentrations in dialysed and
undialysed patients with chronic renal insufficiency. Ann Clin
Biochem 1986; 23: 671–675
4. Savica V, Bellinghieri G, Di Stefano C, Corvaja E, Consolo
F, Corsi M, Maccari F, Spagnoli LG, Villaschi S, Palmieri G:
Plasma and muscle carnitine levels in haemodialysis patients with
morphological-ultrastructural examination of muscle samples.
Nephron 1983; 35: 232–236
5. Moorthy AV, Rosenblum M, Rajaram R, Shug AL: A comparison
of plasma and muscle carnitine levels in patients on peritoneal or
hemodialysis for chronic renal failure. Am J Nephrol 1983; 3:205–
208
6. Gunnell J, Yeun JY, Depner TA, Kaysen GA: Acute-phase response
predicts erythropoietin resistance in hemodialysis and peritoneal
dialysis patients. Am J Kidney Dis 1999; 33: 63–72
7. Kotanko P, Levin NW, Fishbane S, Tarng DC, Berns JS: How can
erythropoietin requirements be reduced in dialysis patients? Semin
Dial 2006; 19(5):363-372
8. Kletzmayr J, Mayer G, Legenstein E Heinz-Peer G, Leitha T,
Hörl WH, Kovarik J: Anemia and carnitine supplementation in
hemodialyzed patients. Kidney Int Suppl 1999; 69:93–106
9. Böhmer T, Rydning A, Solberg HE: Carnitine levels in human
serum in health and disease. Clin Chim Acta 1974; 57(1):55-61
10. Wanner C, Hörl WH: Carnitine abnormalities in patients with
renal insufficiency. Pathophysiological and therapeutical aspects.
Nephron 1988; 50(2):89-102
11. Wanner C, Förstner-Wanner S, Rössle C, Fürst P, Schollmeyer
P, Hörl WH: Carnitine metabolism in patients with chronic renal
failure: Effect of L-carnitine supplementation. Kidney Int Suppl
1987; 22:132-135
12. Mingardi G, Bizzi A, Cini M, Licini R, Mecca G, Garattini S:
Carnitine balance in hemodialyzed patients. Clin Nephrol 1980;
13(6):269-270
13. Bartel LL, Hussey JL, Shrago E: Perturbation of serum carnitine
levels in human adults by chronic renal disease and dialysis therapy.
Am J Clin Nutr 1981; 34(7):1314-1320
14. Bertoli M, Battistella PA, Vergani L Naso A, Gasparotto ML,
Romagnoli GF, Angelini C: Carnitine deficiency induced during
hemodialysis and hyperlipidemia: Effect of replacement therapy.
Am J Clin Nutr 1981; 34(8):1496-1500
15. Reichmann H, van Lindeneiner N: Carnitine analysis in normal
human red blood cells, plasma, and muscle tissue. Eur Neurol 1994;
34(1):40-43
16. Hurot JM, Cucherat M, Haugh M, Fouque D: Effects of L-carnitine
supplementation in maintenance hemodialysis patients: A systematic
review. J Am Soc Nephrol 2002; 13:708–714
Koç Y ve ark: L-Karnitin Tedavisi Hemodiyaliz Hastalarında
Rutin Olarak Kullanılmalı mı?
Cilt/Vol: 19, No: 1, 2010, Sayfa/Page: 29-34
Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
Turkish Nephrology, Dialysis and Transplantation Journal
17. Koistra, MP, Struyvenberg, A van ES: The response to recombinant
human erythropoietin in patients with anemia of ESRD is correlated
with serum carnitine levels. Nephron 1991; 57:127–128
18. Di Jorio BR, Guastaferro P, Cillo N, Cucciniello E, Bellizzi V: Longterm
L-carnitine administration reduces erythropoietin resistance in
chronic hemodialysis patients with thalassemia minor. Drug Target
Insights 2007; 2:1–7
19. Steiber AL, Davis AT, Spry L, Strong J, Buss ML, Ratkiewicz MM,
Weatherspoon LJ: Carnitine treatment improved quality-of-life
measure in a sample of Midwestern hemodialysis patients JPEN J
Parenter Enteral Nutr 2006; 30(1):10-15
20. Labonia WD: L-carnitine effects on anemia in hemodialyzed
patients treated with erythropoietin.Am J Kidney Dis 1995; 26:757-
764
21. Kadiroglu AK, Yilmaz ME, Sit D, Kara IH, Isikoglu B: The
evaluation of postdialysis L-carnitine administration and its effect
on weekly requiring doses of rHuEPO in haemodialysis patients.
Renal Fail 2005; 27:367–372
22. Calvani M, Benatti P, Mancinelli A, D’Iddio S, Giordano V,
Koverech A, Amato A, Brass EP: Carnitine replacement in endstage
renal disease and hemodialysis. Ann N Y Acad Sci 2004;
1033:52-66
23. Matsumura M, Hatakeyama S, Koni I, Mabuchi H,Muramoto H:
Correlation between serum carnitine levels and erythrocyte osmotic
fragility in hemodialysis patients. Nephron 1996; 72: 574–578
24. Handelman GJ: Debate forum: Carnitine supplements have not
been demonstrated as effective in patients on long-term dialysis
therapy. Blood Purif 2006; 24(1):140-142
25. Semeniuk J, Shalansky KF, Taylor N, Jastrzebski J, Cameron EC:
Evaluation of the effect of intravenous l-carnitine on quality of life
in chronic hemodialysis patients. Clin Nephrol 2000; 54(6):470-
477
26. Caruso U, Leone L, Cravotto E, Nava D: Effects of L-carnitine
on anemia in aged hemodialysis patients treated with recombinant
human erythropoietin: A pilot study. Dial Transplant 1998; 27:
498–506
27. Lilien MR, Duran M, Quak JM, Frankhuisen JJ, Schröder CH:
Oral L-carnitine does not decrease erythropoietin requirement in
pediatric dialysis Pediatr Nephrol 2000; 15:17–20
28. Fagher B, Cederblad G, Eriksson M Monti M, Moritz U, Nilsson-
Ehle P, Thysell H: L-carnitine and haemodialysis: Double blind
study on muscle function and metabolism and peripheral nerve
function. Scand J Clin Lab Invest 1985; 45:169–178
29. Vaux EC, Taylor DJ, Altmann P, Rajagopalan B, Graham K, Cooper
R, Bonomo Y, Styles P: Effects of carnitine supplementation on
muscle metabolism by the use of magnetic resonance spectroscopy
and near-infrared spectroscopy in end-stage renal disease. Nephron
Clin Pract 2004; 97(2):c41-48
30. Lynch KE, Feldman HI, Berlin JA, Flory J, Rowan CG, Brunelli
SM: Effects of L-carnitine on dialysis-related hypotension and
muscle cramps: A meta-analysis. Am J Kidney Dis 2008; 52(5):962-
971
31. National Kidney Foundation: K/DOQI clinical practice guidelines
for anemia of chronic kidney disease. Am J Kidney Dis 2001;
37(suppl 1):182-238
32. Locatelli F, Aljama P, Bárány P, Canaud B, Carrera F, Eckardt
KU, Hörl WH, Macdougal IC, Macleod A, Wiecek A, Cameron
S: European Best Practice Guidelines Working Group: Revised
European guidelines for the management of anemia in patients with
chronic renal failure. Nephrol Dial Transplant 2004; 19(suppl 3):
iii6-iii15
33. NKF-K/DOQI clinical practice guidelines for anemia in chronic
kidney disease. Am J Kidney Dis 2006; 47(Suppl 3):1–145

Thank you for copying data from http://www.arastirmax.com