| Peritoneal dialysis (PD) is one of methods of renal replacement therapy in patients with end-stage renal disease (ESRD). Similar to hemodialysis (HD) patients, PD patients are at greater risk for developing dialysis-related carnitine disorder (DCD), long-term dialysis therapy can lead to a significant reduction in plasma and tissue free carnitine (FC) levels and an increase in the ratio of acyl carnitine to free carnitine (AC/FC). These alterations may associate with such clinical symptoms as muscle weakness, pain, intradialytic hypotension (IDH), or suboptimal response to recombinant human erythropoietin (rHuEPO). Exogenous L-carnitine, administered intravenously, had been shown benefits in alleviating uremic myopathy, improving exercise tolerance, reducing the rHuEPO requirement and complications for HD patients. We could not prove the same benefits in PD patients of carnitine supplementation because of the small numbers of researches.Objective: To investigate the effect of L-carnitine supplementation on plasma carnitine fractions and analyse the effect of the treatment on muscle symptoms and anemia in chronic peritoneal dialysis patients.Methods: 38 PD patients were experiencing obvious muscular symptoms and anemia or not were selected to perform the L-carnitine treatment study, also randomly selected 29 PD patients who were completely free of muscular symptoms, and anemia or not. All patients had been stable on peritoneal dialysis before July 2008 were investigated concerning carnitine profiles (total carnitine (TC), FC, AC). Compared plasma carnitine status between those two groups. Patients with muscular symptoms were given a every other day dose of 15 mg/kg L-carnitine intravenous injection for 24 weeks, Then, assess whether L-carnitine can alleviate PD patients'muscular symptoms and to understand how carnitine affects the haemoglobin (Hb), lipid profiles in dialyzed patients, and report severe adverse effect. Results: 1. Plasma FC decreased gradually in accordance with months on dialysis with a significant correlation, r=-0.711, P<0.001. Contrast with FC leves, the AC/FC ratio was shown to increase gradually in accordance with months on dialysis, r=0.58, P<0.001.2. Plasma FC levels in patients with muscle symptoms were significantly lower than patients without muscle symptoms, (28.11±3.11)μmol/L vs (36.25±6.47)μmol/L, P<0.01, and AC/FC ratio was reverse, patients with muscle symptoms were significantly higher than patients without muscle symptoms, (0.84±0.15)μmol/L vs (0.41±0.20)μmol/L, P<0.01. Plasma TC levels of the two groups without statistical significance.3. (1) Patients treated with L-carnitine demonstrated an improvement in muscular symptoms. The baseline visual analogue scale (VAS) of muscle pain was (23.66±4.96) mm, after 24 weeks supplementation, carnitine group had lesser score than baseline, (19.34±3.46) mm, P<0.01. The VAS of muscle weakness was also decreased with L-carnitine therapy, (27.76±7.6) mm vs (21.11±3.60) mm, P<0.01. L-carnitine treatment also had positive effects on handgrip strength, (164.34±58.99) N vs (248.55±69.74) N, P<0.01. (2) After 24 weeks of L-carnitine treatment, plasma FC, AC, and TC had increased obviously, conversely, AC/FC ratio was reduced significantly compared with baseline. (3) The Hb leves increased from 106.35±7.65 to 116.3±4.93 g/L while the rHuEPO requirement decreased from 148.04±31.67 to 127.50±30.17 U/(kg·week) in carnitine patients after 24 weeks, and the two aspects were unchanged in controls. (4) Before and after L-carnitine treatment, there were no significant differences in each lipid parameter, and no severe adverse effect was reported.Conclusions: Plasma and tissue L-carnitine deficiency were correlated with months on dialysis. L-carnitine supplementation had beneficial effects in such clinical symptoms associated with carnitine deficiency of peritoneal dialysis patients. Our study has show that L-carnitine therapy can alleviate muscle symptoms, strengthen muscle power, increase Hb and reduce the rHuEPO requirement without severe adverse effect.
|
PDF Full Text Request