2012 Volume 45 Issue 10 Pages 955-963
The aim of this study was to evaluate the effects of levocarnitine chloride (L-cartine®, LC) on maintenance hemodialysis patients who received DA at 40 μg/week or rHuEPO at 9,000 U/week by examining the changes in serum carnitine levels during hemodialysis (study 1), and the treatment effects of LC on ESA-resistant anemia (study 2) and dialysis-associated muscle symptoms (study 3). In study 1, we monitored 100 patients. The average levels of total carnitine (TC) and free carnitine (FC) within one year after the introduction of dialysis were 57.9±18.2 and 38.8±13.6 μmol/L, respectively. At one year, however, these levels significantly decreased to 39.3±18.6 (TC) and 25.0±12.5 (FC) μmol/L (p<0.01), respectively, and continued to decrease in accordance with the duration of hemodialysis. In study 2, 32 patients (treated group) who wanted to receive LC orally at a dose of 2×300 mg daily were compared with 43 patients without treatment (non-treated group). The TC and FC levels after 12 weeks in the treated group were 175.0±95.5 and 122.3±64.6 μmol/L, respectively. The erythropoietin resistance index (ERI：ESA dose (units/week)/hemoglobin (g/dL)) significantly decreased in the treated group from 1,041 to 737 (24 weeks)(p<0.01), while it did not decrease in the non-treated group. In study 3, 32 patients (treated group) were scored using a questionnaire by nurses regarding the four symptoms (asthenia, muscular cramping, intradialysis hypotension, and dyspnea after exertion) before and after treatment with LC (at 12 and 24 weeks), and the effects of LC on symptom scores were evaluated. Asthenia and muscular cramping exhibited noticeable changes after treatment (p<0.001). Our studies revealed the beneficial effects of LC treatment on ESA-resistant anemia and dialysis-associated muscle symptoms, with no significant adverse events.
