Background

Carnitine plays a key role in energy production in the myocardium and is efficiently removed by continuous kidney replacement therapy (CKRT). Effects of levocarnitine supplementation on myocardial function in children receiving CKRT have not been investigated.

Methods

This controlled pilot cohort study of 48 children investigated effects of levocarnitine supplementation on myocardial strain in children receiving CKRT for acute kidney injury (AKI). Children (n = 9) with AKI had total (TC) and free plasma carnitine (FC) measurements and echocardiogram for longitudinal and circumferential strain at baseline (prior to CKRT) and follow-up (on CKRT for > 1 week with intravenous levocarnitine supplementation, 20 mg/kg/day). Intervention group was compared with three controls: (1) CKRT controls (n = 10) received CKRT > 1 week (+AKI, no levocarnitine), (2) ICU controls (n = 9) were parenteral nutrition-dependent for > 1 week (no AKI, no levocarnitine), and (3) healthy controls (n = 20).

Results

In the Intervention group, TC and FC increased from 36.0 and 18 μmol/L to 93.5 and 74.5 μmol/L after supplementation. TC and FC of unsupplemented CKRT controls declined from 27.2 and 18.6 μmol/L to 12.4 and 6.6 μmol/L, which was lower vs. ICU controls (TC 32.0, FC 26.0 μmol/L), p < 0.05. Longitudinal and circumferential strain of the Intervention group improved from − 18.5% and − 18.3% to − 21.1% and − 27.6% after levocarnitine supplementation; strain of CKRT controls (-14.4%, -20%) remained impaired and was lower vs. Intervention and Healthy Control groups at follow-up, p < 0.05.

Conclusions

Levocarnitine supplementation is associated with repletion of plasma carnitine and improvement in myocardial strain and may benefit pediatric patients undergoing prolonged CKRT.

中文翻译：

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补充左卡尼汀对接受持续肾脏替代治疗的急性肾损伤儿童心肌劳损的影响：一项初步研究

背景

肉碱在心肌的能量产生中起关键作用，并通过连续肾脏替代疗法 (CKRT) 有效去除。尚未研究补充左卡尼汀对接受 CKRT 的儿童心肌功能的影响。

方法

这项针对 48 名儿童的对照试点队列研究调查了补充左卡尼汀对接受 CKRT 治疗急性肾损伤 (AKI) 的儿童心肌劳损的影响。患有 AKI 的儿童 ( n = 9) 在基线（CKRT 之前）和随访（CKRT超过1 周，静脉补充左卡尼汀）时进行了总 (TC) 和游离血浆肉碱 (FC) 测量以及纵向和周向应变的超声心动图, 20 毫克/公斤/天)。干预组与三个对照组进行了比较：（1）CKRT 对照组（n = 10）接受 CKRT > 1 周（+AKI，无左卡尼汀），（2）ICU 对照组（n = 9）肠外营养依赖于>1 周（无 AKI，无左卡尼汀）和 (3) 健康对照 ( n = 20)。

结果

在干预组中，补充后 TC 和 FC 从 36.0 和 18 μmol/L 增加到 93.5 和 74.5 μmol/L。未补充 CKRT 对照的 TC 和 FC 从 27.2 和 18.6 μmol/L 下降到 12.4 和 6.6 μmol/L，低于 ICU 对照（TC 32.0，FC 26.0 μmol/L），p < 0.05。在补充左卡尼汀后，干预组的纵向和周向应变从 - 18.5% 和 - 18.3% 提高到 - 21.1% 和 - 27.6%；CKRT 对照组（-14.4%，-20%）的应变仍然受损，并且在随访中低于干预组和健康对照组，p < 0.05。

结论

左卡尼汀补充剂与血浆肉碱的补充和心肌劳损的改善有关，并且可能有益于接受长期 CKRT 的儿科患者。