Lynch Katherine E, Feldman Harold I, Berlin Jesse A, Flory James, Rowan Christopher G, Brunelli Steven M
Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Am J Kidney Dis. 2008 Nov;52(5):962-71. doi: 10.1053/j.ajkd.2008.05.031. Epub 2008 Aug 15.
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.
Systematic review and meta-analysis.
SETTING & POPULATION: Adult patients with end-stage renal disease receiving long-term hemodialysis.
All published English-language reports of randomized placebo-controlled trials of L-carnitine supplementation in adult long-term hemodialysis patients.
Supplemental L-carnitine (or placebo) for at least 8 weeks.
Random-effects pooled odds ratio for intradialytic cramping or hypotension in L-carnitine-treated participants.
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).
The small number of available studies yielded limited statistical power. In addition, there was considerable interstudy heterogeneity.
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.
左旋肉碱是一种内源性化合物，被认为有助于治疗透析相关的低血压和肌肉痉挛；然而，缺乏针对这些适应症的充分证据。
系统评价和荟萃分析。
接受长期血液透析的终末期肾病成年患者。
所有已发表的关于成年长期血液透析患者补充左旋肉碱的随机安慰剂对照试验的英文报告。
补充左旋肉碱（或安慰剂）至少8周。
左旋肉碱治疗参与者透析期间痉挛或低血压的随机效应合并比值比。
在317篇可能相关的文章中，7篇（共纳入193例患者）符合纳入标准。4篇文章报告了低血压和痉挛的结果，1篇仅报告了低血压的结果，2篇仅报告了痉挛的结果。使用所有6项相关试验的数据，补充左旋肉碱后痉挛的合并比值比为0.30（95%置信区间，0.09至1.00；P = 0.05）。对5项研究透析期间低血压对补充左旋肉碱反应的分析得出合并比值比为0.28（95%置信区间，0.04至2.23；P = 0.2）。
可用研究数量较少，统计效力有限。此外，研究间存在相当大的异质性。
尽管在肌肉痉挛方面有一定提示，但现有证据并未证实补充左旋肉碱对透析相关肌肉痉挛或透析期间低血压有有益作用。这两种情况都需要以大型严格随机试验的形式进行更多研究。
