The effect of L-carnitine therapy on anaemia therapy in paediatric patients on regular haemodialysis

Introduction
Renal anaemia is a common complication of haemodialysis patients. Hyporesponsiveness to erythropoietin (EPO) has been known as an important factor in poor recombinant human erythropoietin efficacy in the treatment of renal anaemia. Moreover, an increased erythropoiesis resistance index (ERI) may be associated with inflammation and lead to an increased mortality. The aim of the study to study the effect of L-carnitine (LC) therapy on anaemia and erythropoietin therapy in paediatric patients on regular haemodialysis.

Material and methods
This prospective study was conducted on 30 CKD paediatric patients on regular haemodialysis attending the haemodialysis unit in Menoufia University. They were classified into 2 groups: 15 CKD patients receiving oral L-carnitine (LC) in a dose of 100 mg/kg per day in 3 divided doses – maximum 3 g per day and erythropoietin therapy in a dose of 100-300 IU/kg 3 times per week, considered as group I, and 15 CKD patients receiving erythropoietin therapy only (group II). Patients were subjected to history taking, clinical examination, and laboratory investigations including CBC, pre- and post- dialysis serum urea. Creatinine, iron profile, Ca, phosphorus, intact parathormone, erythropoiesis-stimulating agent dose (ESA), and erythropoietin-resistance index (ERI) were calculated at the baseline and then on follow-up after 6 months.

Results
There was a statistically significant increase in Hb level in patients receiving both L-carnitine and erythropoietin therapy (group I) when compared to patients receiving erythropoietin only (group II) after 6 months. Moreover, there was a significant decrease in the mean erythropoietin-stimulating agent (ESA) dose and erythropoietin-resistance index (ERI) in group I with mean ±SD of 95.12 IU/kg ±10.99 IU/kg, 229.59 ±21.95 IU/kg/g when compared to group II at 149.11 ±43.98 IU/kg, 360.15 ±71.105 IU/kg/g (p-value 0.00), respectively.

Conclusions
L-carnitine may be used as an adjuvant therapy in paediatric haemodialysis patients to decrease the requirement of erythropoietin-stimulating agents (ESA) dosage and erythropoietin-resistance index (ERI) while maintaining adequate levels of serum haemoglobin.