Effects of L-carnitine on dialysis-related hypotension and muscle cramps: a meta-analysis.

Abstract

BACKGROUND:

L-Carnitine is an endogenous compound thought to be helpful in treating patients with dialysis-related hypotension and muscle cramps; however, sufficient evidence for these indications is lacking.

STUDY DESIGN:

Systematic review and meta-analysis.

SETTING & POPULATION:

Adult patients with end-stage renal disease receiving long-term hemodialysis.

SELECTION CRITERIA FOR STUDIES:

All published English-language reports of randomized placebo-controlled trials of L-carnitine supplementation in adult long-term hemodialysis patients.

INTERVENTION:

Supplemental L-carnitine (or placebo) for at least 8 weeks.

OUTCOME:

Random-effects pooled odds ratio for intradialytic cramping or hypotension in L-carnitine-treated participants.

RESULTS:

Of 317 potentially relevant articles, 7 (total enrollment of 193 patients) met criteria for inclusion. Four articles reported results for both hypotension and cramps, 1 had results for only hypotension, and 2 reported results for only cramps. Using data from all 6 relevant trials, the pooled odds ratio for cramping after L-carnitine supplementation was 0.30 (95% confidence interval, 0.09 to 1.00; P = 0.05). Analysis of the 5 studies examining the response of intradialytic hypotension to l-carnitine supplementation yielded a pooled odds ratio of 0.28 (95% confidence interval, 0.04 to 2.23; P = 0.2).

LIMITATIONS:

The small number of available studies yielded limited statistical power. In addition, there was considerable interstudy heterogeneity.

CONCLUSIONS:

Although suggestive in the case of muscle cramping, the available evidence does not confirm a beneficial effect of L-carnitine supplementation on dialysis-related muscle cramping or intradialytic hypotension. Additional study in the form of large rigorous randomized trials is needed in both cases.

• Authors: Katherine E Lynch, Harold I Feldman, Jesse A Berlin, James Flory, Christopher G Rowan, Steven M Brunelli
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 52 Issue 5 Pg. 962-71 (Nov 2008) ISSN: 1523-6838 [Electronic] United States
• PMID: 18706751 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Carnitine

Topics

• Carnitine (therapeutic use)
• Humans
• Hypotension (drug therapy, etiology)
• Muscle Cramp (drug therapy, etiology)
• Renal Dialysis (adverse effects)