Association between Levocarnitine Treatment and the Change in Knee Extensor Strength in Patients Undergoing Hemodialysis: A Post-Hoc Analysis of the Osaka Dialysis Complication Study (ODCS)

Abstract

Carnitine deficiency is prevalent in patients undergoing hemodialysis, and it could result in lowered muscle strength. So far, the effect of treatment with levocarnitine on lower limb muscle strength has not been well described. This observational study examined the association between treatment with levocarnitine with the change in knee extensor strength (KES) in hemodialysis patients. Eligible patients were selected from the participants enrolled in a prospective cohort study for whom muscle strength was measured annually. We identified 104 eligible patients for this analysis. During the one-year period between 2014 to 2015, 67 patients were treated with intravenous levocarnitine (1000 mg per shot, thrice weekly), whereas 37 patients were not. The change in KES was significantly higher (p = 0.01) in the carnitine group [0.02 (0.01–0.04) kgf/kg] as compared to the non-carnitine group [−0.02 (−0.04 to 0.01) kgf/kg]. Multivariable-adjusted regression analysis showed the positive association between the change in KES and the treatment with levocarnitine remained significant after adjustment for the baseline KES and other potential confounders. Thus, treatment with intravenous levocarnitine was independently and positively associated with the change in KES among hemodialysis patients. Further clinical trials are needed to provide more solid evidence.

Frailty and Clinical Outcomes in Patients Treated With Hemodialysis: A Prospective Cohort Study

“…Although some have suggested that dialysis patients should be routinely evaluated for frailty, 18 the utility of this approach is uncertain given the lack of proven interventions. Candidate therapies, such as exercise training, 19 androgen supplementation, 20 carnitine administration, 21 and perhaps other forms of nutritional support. 22 The high prevalence of frailty, the high associated costs, 23 and the excess risk of associated adverse outcomes indicate the need for clinical trials to identify effective treatments.…”

Patient‐reported difficulty in activities of daily living and corresponding muscle weakness in elderly patients undergoing haemodialysis

“…Muscle strengths were expressed in the unit of kilogram force (kgf). Hip abduction strength and knee extension strength were standardized for body size by dividing them by body weight (in kilogram) after haemodialysis (“dry weight”) 25 …”