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L-Karnitin Tedavisi Hemodiyaliz Hastalarında Rutin Olarak Kullanılmalı mı?

Should Carnitine Treatment Be Used for All Hemodialysis Patients?

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2010.1001.04

Keywords (Original Language):

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.

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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
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