Combined therapy with L-carnitine and erythropoietin of anemia in chronic kidney failure patients undergoing hemodialysis

Abstract

Objectives: The aim of this study was to analyze the influence of combined therapy with L-carnitine and erythropoietin on selected blood morphology parameters in patients treated with hemodialysis and to assess whether combined therapy could decrease the requirement for exogenous erythropoietin.

Patients and methods: The results of anemia treatment were compared in three groups of patients: 27 patients treated with L-carnitine and erythropoietin, 15 patients treated with erythropoietin and 9 patients treated only with L-carnitine. The patients were treated for 6 months. L-carnitine was given orally at a dose of 4 x 250 mg daily. Erythropoietin was administered intravenously after each hemodialysis session and the mean dose of erythropoietin at the beginning of observation was 5642 ±2134 units/week. Before treatment serum concentrations of free and total carnitine, parathormone (PTH), aluminium, lead were determined and basic laboratory examinations were performed. The blood morphology was evaluated once a month.

Results: Combined therapy resulted in the improvement of blood morphology parameters (hemoglobin [Hb] before treatment 9.9 ±1.4 g/dl, during treatment 10.7 ±1.6 g/dl), compared to treatment with erythropoietin (Hb before treatment 9.5 ±1.2 g/dl, during treatment 9.9 ±1.4 g/dl) or Lcarnitine alone (Hb before treatment 11.3 ±1.0 g/dl, during treatment 12.0 ±1.1 g/dl). Combined therapy was associated with the reduction of erythropoietin dosage during treatment from 6287 ±1987 units/week to 2286 ±1684 units/week. The correlation between serum carnitine concentration and erythrocyte osmotic resistance indicates indirectly the beneficial effect of L-carnitine administration on erythrocyte cell membrane stabilization.