Department of Nephrology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Department of Cardiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Pediatr Nephrol. 2021 Jun;36(6):1607-1616. doi: 10.1007/s00467-020-04862-3. Epub 2021 Jan 3.
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.
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).
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.
Levocarnitine supplementation is associated with repletion of plasma carnitine and improvement in myocardial strain and may benefit pediatric patients undergoing prolonged CKRT.
肉碱在心肌能量产生中起着关键作用，可被连续肾脏替代疗法（CKRT）有效清除。左旋肉碱补充对接受 CKRT 的儿童心肌功能的影响尚未得到研究。
本研究为一项 48 名儿童的对照性试点队列研究，研究了左旋肉碱补充对急性肾损伤（AKI）接受 CKRT 的儿童心肌应变的影响。9 名 AKI 患儿在基线（CKRT 前）和随访时（CKRT 超过 1 周并静脉内补充左旋肉碱 20mg/kg/天）进行了总（TC）和游离血浆肉碱（FC）测量和超声心动图检查，以评估纵向和环向应变。干预组与三组对照进行比较：（1）CKRT 对照组（n=10）接受 CKRT 超过 1 周（+AKI，无左旋肉碱），（2）ICU 对照组（n=9）接受肠外营养超过 1 周（无 AKI，无左旋肉碱），（3）健康对照组（n=20）。
在干预组中，TC 和 FC 从补充前的 36.0 和 18μmol/L 增加到补充后的 93.5 和 74.5μmol/L。未补充左旋肉碱的 CKRT 对照组的 TC 和 FC 从 27.2 和 18.6μmol/L 下降到 12.4 和 6.6μmol/L，低于 ICU 对照组（TC 32.0，FC 26.0μmol/L），p<0.05。干预组的纵向和环向应变从补充后的-18.5%和-18.3%改善至-21.1%和-27.6%；CKRT 对照组的应变（-14.4%，-20%）仍然受损，且在随访时低于干预组和健康对照组，p<0.05。
左旋肉碱补充与血浆肉碱的补充有关，并改善心肌应变，可能有益于接受长时间 CKRT 的儿科患者。
