Abstract
The improvement of malnutrition with levocarnitine in maintenance hemodialysis (MHD) patients is controversial. We performed a meta-analysis to evaluate the efficacy of levocarnitine in improving malnutrition in MHD patients. We performed a literature search for relevant articles related to the treatment of malnutrition by L-carnitine in MHD patients in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases. We set the publication dates from 1950 to July 2019. The levels of albumin, prealbumin, total protein, and transferrin before and after treatment were used for assessing malnutrition. Twenty-seven studies were included in the present analysis. The results of the random effects model indicated that L-carnitine treatment improved the albumin level in patients on MHD patients. The pooled standardized mean difference of albumin level was 2.51 (95% confidence interval (CI): 2.13−2.90, P<0.001). The pooled total protein level was 3.83 (95% CI: 2.41−5.24, P = 0.000) and the pooled transferrin level was 0.35 (95% CI: 0.18−0.52, P = 0.000). Significant differences were observed with the total protein and transferrin levels. The results indicated that levocarnitine significantly improved the prealbumin level in patients on MHD. The pooled prealbumin level was 70.86 (95% CI: 42.99−98.73, P = 0.000). No publication bias was detected (P>0.05). The present meta-analysis indicated that L-carnitine can have a favorable effect on malnutrition biomarkers in patients on MHD, including the increase in albumin, total protein, transferrin, and prealbumin levels. The L-carnitine could be an option for treatment of MHD patients.
Highlights
As the prevalence of chronic kidney disease (CKD) increases every year, the prevalence of end-stage renal disease increases [1]
Malnutrition in maintenance hemodialysis (MHD) patients is associated with complications, such as hyperparathyroidism, anemia, acidosis, etc
L-carnitine is a type of water-soluble amino acids that could carry long-chain fatty acids into the mitochondria to participate in reactions and provide energy as a form of adenosine triphosphate [28]
Summary
As the prevalence of chronic kidney disease (CKD) increases every year, the prevalence of end-stage renal disease increases [1]. Maintenance hemodialysis (MHD) has become the mainstay of treatment in patients with end-stage renal disease [2]. The number of patients on global MHD is increasing rapidly, with the number of patients on dialysis increasing by 6% each year. It is estimated that more than 2.2 million patients will undergo dialysis globally by 2020 [3]. The incidence of malnutrition in patients undergoing MHD was reported to be 15−75%, of which about 6−8% of the patients had severe malnutrition [4]. Studies have shown that malnutrition is one of the main factors affecting the survival of patients undergoing dialysis [5]. The concept of malnutrition in CKD dialysis patients usually refers to nutritional abnormality caused by insufficient dietary protein intake or excessive
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