Should Carnitine Treatment Be Used for All Hemodialysis Patients?

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. RESULTS: 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.