| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 92 === Uremic patients receiving chronic peritoneal dialysis (PD), similar to hemodialysis patients, were associated with a reduction in plasma and tissue free carnitine concentration and high ratio of acyl-carnitine to free carnitine (AC/FC). The disturbed L-carnitine concentrations were referred to as dialysis–related carnitine deficiency which was associated with symptoms of uremic myopathy. Uremic myopathy frequently manifested with muscle weakness/fatigue, cramps/pain, and limited exercise tolerance and endurance. Oral low-dose supplement with L-carnitine had been shown benefits in alleviating skeletal muscle symptoms and increased physical activity by reducing AC/FC ratio in hemodialysis patients.
We performed a prospective open-label parallel controlled study to evaluate the effects of oral L-carnitine (600 mg/day) supplementation for six months on muscle symptoms and quality of life. Three components of muscle symptoms (muscle weakness/fatigue, muscle cramps/pain, and aching excluding pain during cramps) of PD patients were assessed via three standard un-graded 100-mm visual analog scales (VAS) separately at baseline, the 3rd month and the 6th month.The quality of life was measured by 36-item short-form health survey (SF-36) at baseline and the 6th month. Recombinant human erythropoietin (epoietin, rhuEPO) responsiveness, cardiac function and symptoms of heart failure were also monitored.
Forty-five patients with uremic myopathy were recruited into carnitine group (n=22) and control group (n=23). The 100mm VAS of muscle weakness/fatigue did not differ at entry. The carnitine group demonstrated an improvement as comparison to the control group (repeated measures ANOVA, overall P = 0.05). The 100-mm VAS of muscle cramps/pain of both was similar at baseline. After six months supplementation, carnitine group had lesser muscle cramps/pain than control group (overall P = 0.02). L-carnitine therapy also had positive effects on physical functioning, physical role, general health and emotional role concepts of SF-36 (P < 0.05). The epoietin responsiveness, ejection fraction of left ventricle and symptoms of heart failure did not have significant changes. No severe adverse effect was reported.
The oral low-dose supplementation of L-carnitine is well tolerated.L-carnitine therapy demonstrates significant alleviation of skeletal muscle symptoms and improves quality of life in chronic PD patients.
|
|---|
