Is their a role for oral L-carnitine therapy in anemia and cardiac dysfunction management in Egyptian patients on maintenance hemodialysis?

L-Carnitine is a short organic hydrosoluble molecule and is present in biological materials like free carnitine and acylcarnitines, which constitute the carnitine system. Long-term intermittent hemodialysis is associated with a reduction in plasma and tissue L-carnitine levels. Available studies on carnitine supplementation suggest the use of this molecule in dialysis, especially for those patients with cardiac complications, impaired exercise and functional capacities, and increased episodes of hypotension. Moreover, in some patients, the improved stability of erythrocyte membranes with L-carnitine supplementation may decrease erythropoietin requirements, thus, leading to a reduction of dialytic costs. To study if there a possible advantageous effects for L-Carnitine oral supplementation in anemia and cardiac dysfunction management in a cohort of Egyptian patients on maintenance hemodialysis. Fifty- five patients with chronic renal failure on maintenance hemodialysis were classified into 2 groups: L- Carnitine group: 20 patients [12 male and 8 female, Mean age 47.66 +/- 17.73 years, hemodialysis duration 51.36 +/- 18.14 months, subjected to three sessions /week reaching Kt/V of 1.48 +/- 0.37] they received oral L-Carnitine therapy 1.500 mg/day and Control group: 35 patients [24 male and 11 female, mean age 37.9 +/- 14.7 years, hemodialysis duration 53.83 +/- 15.17 months, subjected to three sessions /week reaching Kt/V of 1.33 +/- 0.28]. Both groups were on Erythropoietin therapy and IV iron whenever indicated. Echogardiographic studies were performed before and at the end of the study. Serum hemoglobin were comparable in the L- carnitine group and control group at the start and six months after therapy [8.63 +/- 1.77 and 9.39 +/- 2.02 gm/dl, P= 0.18, 10.49 +/- 1.60 and 10.29 +/- 2.48 gm/dl P= 0.76 respectively]. The weekly maintenance dose of Erythropoietin inspite of being lower in L-Carnitine group [Mean = 4750.12 +/- 2137.04 units] compared to control group [Mean= 5515.15 +/- 2292.94 units] it does not reach a statistical significance [P=0.24]. No significant improvement could be observed in echogardiographic findings in the L- Carnitine group after therapy. The role of L-Carnitine in hemodialysis patients is questionable. Our study revealed no observed significant improvement in echocardiographic findings 6 months after therapy. However, -a statistically non significant- reduction in Erythropoietin dose was achieved in the L- carnitine-treated compared to the control group while maintaining comparable target hemoglobin in both groups. Long-term studies including larger number of patients are required to clarify its role in hemodialysis patients

Sleep disorders in Egyptian hemodialysis patients in Mansoura Urology and Nephrology center

Many patients with kidney failure undergoing dialysis therapy suffer from sleep disturbances. The prevalence of such sleep disorders is higher when compared to the general population. Patients were recruited from the 3 haemodilaysis units of Urology and Nephrology Center, Mansoura University, Egypt over 4 months period. Eighty eight patients [41.59 +/- 16.3 years] who satisfied our inclusion criteria were enrolled in our study. The demographic and clinical data including insomnia as well as the biochemical parameters were collected by the attending nephrologists. Other sleep disorders such as restless leg syndrome [RLS], obstructive sleep apnoea syndrome [OSAS], excessive daytime sleepiness [EDS], narcolepsy and sleep walking were investigated by questionnaire of the International Restless Legs Syndrome Study Group [IRLSSG], the Berlin Questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders [ICSD] and the specific questions of Hatoum's sleep questionnaire, respectively. Sleep disorders were prevalent in our patients [79.5%] and such prevalence was statistically significant [Chi-squared=30.7, p=<0.0001]. The most common sleep abnormality was insomnia [65.9%], followed by RLS [42%], OSAS [31.8%], snoring [27.3%], EDS [27.3%] and narcolepsy [15.9%] while the least was sleep walking [3.4%]. Insomnia correlated with anemia [r=o.31, p=0.003], anxiety [r=0.279, p=0.042], depression [r=0.298, p=0.24] and RLS [r=0.327, p=0.002]. Also, RLS correlated with hypoalbuminemia [r=0.41, p=<0.0001], anemia [r=0.301 and p=0.046], hyperphosphatemia [r=0.343 and p=0.001], and excessive daytime sleepiness correlated with OSAS [r=0.5, p=<0.0001], snoring [r=0.341, p=0.001], and social worry [r=0.27, p=0.011]. Of note, no correlation was observed between the evaluated sleep disorders and patients' gender. The indicatives for insomnia among our study population were inadequate dialysis [OR=8.71, p=0.001], anemia [OR=3.58, p=0.012], hypoalbuminemia [OR=2.71, p=0.044] and RLS [OR=8.50, p=0.0003]. However, anemia [OR=2.67, p=0.034], malnurishment [OR=9.23, p=0.0002] and hyperphosphatemia [OR=5.14, p=0.0005] were the associates of RLS. Sleep disorders are quite common in the Egyptian hemodialysis populations especially those who are anemic, malnourished; and underdialyzed. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results and population-specific sleeppromoting interventions during clinical practice are warranted