US-ITALY L-CARNITINE HEMODIALYSIS UTILIZATION SURVEY

The objective of this physicians' L-carnitine (carnitine) hemodialysis utilization survey was to characterize the reasons for carnitine admi nistration in clinical practice in both Europe (Italy) min the United States and the consequent clinical effects. A total of 9 dialysis cent ers (3 in Italy and 6 in the U.S.), 11 physicians, and 171 end-stage r enal disease (ESRD) patients participated in the survey. The carnitine dose was primarily 2 g administered intravenously 3 times a week afte r each dialysis session; 1 U.S. dialysis center administered an averag e intravenous dose of 3.6 g. One Italian center administered ora carni tine. Carnitine was given to those patients who did not respond to sta ndard therapy and were experiencing primarily weakness and cramps. It was also given to help control intradialytic hypotension, cardiomegaly , erythropoietin (EPO) insensitivity, and occasionally for other manif estations such as loss of appetite, chest and other pain, hand tremor; sexual dysfunction, and depression. A statistically significant good- to-excellent overall response for severe weakness (p = 0.03) and sever e cramping (p = 0.03) with carnitine supplementation was reported for most of the patients in this survey. Significant improvement of severe EPO insensitivity (p = 0.04) was also noted. A positive trend in the good-to-excellent overall response for severe intradialytic hypotensio n was observed. There were too few reported instances of cardiomegaly, loss of appetite, pain, hand tremor, sexual dysfunction, depression, and fatigue to evaluate statistically. A statistically, significant re lationship (p = 0.0001) between duration-of-benefit and duration-of-tr eatment was observed. There were significant differences in pre-carnit ine compared to during-carnitine serum albumin concentrations (p = 0.0 001). A follow-up double-blind, placebo-controlled clinical study on t he benefits of intravenous L-carnitine on hemodialysis patients will b e conducted based on the findings of this physicians' utilization surv ey.