Beneficial effects of combination therapy of intradialytic parenteral nutrition and oral l-carnitine administration

Abstract

According to the review article on nutritional support in hemodialysis patients by Bossola et al. [1], intradialytic parenteral nutrition (IDPN) seems to improve nutritional parameters such as serum albumin and body weight, but the effects of IDPN on long-term survival remain controversial. IDPN can provide energy of 7–8 kcal/kg/day and protein of 0.3–0.4 g/kg/day at best, and in order to attain the recommended nutritional requirements, spontaneous oral intake must reach [0.8 g/kg/day for protein and [20 kcal/kg/day for energy [2]. Therefore, the effects of IDPN on nutritional status often seem uncertain. In some patients, the loss of muscle mass occurs despite IDPN. We report here our experience of the use of L-carnitine in combination with IDPN in patients on chronic hemodialysis. Our IDPN therapy consisted of 200 ml of 6.1 % amino acids solution, 200 ml of 50 % dextrose solution, and 100 ml of 20 % soy lipid solution. Total energy intake including IDPN ranged from 30 to 35 kcal/kg/day. These were infused through the blood line throughout each entire dialysis session. In 6 patients whose nutritional conditions, such as body weight and muscle mass, had not improved by IDPN for 6 months, oral L-carnitine of 300 mg was additionally administered 20 min before each dialysis session. Body composition by bioimpedance method, serum levels of high-sensitivity C-reactive protein (hs-CRP) and albumin were evaluated every 3 months for 1 year. The effects of L-carnitine added to IDPN were shown in Table 1. During the 6 months on IDPN therapy alone, the fat mass significantly increased, while the muscle mass significantly decreased. With additive L-carnitine administration, however, the muscle mass significantly increased at month 3. Serum albumin levels increased in 2 patients, decreased in 3, and did not change in one. The reason of such inconsistent changes of serum albumin remains unknown. Six months after L-carnitine administration, we found a significant decrease in serum hs-CRP level, which persisted 1 year after L-carnitine administration. However, its clinical impacts may be modest, because serum hs-CRP level before L-carnitine administration was low at 0.051 mg/dL. Many studies have indicated that hemodialysis is a protein-catabolic procedure, and hemodialysis itself may be a cause of malnutrition leading to a loss of lean M. Tsunoda (&) Department of Nephrology and Dialysis, H. N. Medic Sapporo-Higashi, 1-26, Kita-19 Higashi-7, Higashi-ku, Sapporo 065-0019, Japan e-mail: tndmstk@hnmedic.jp