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Patients on hemodialysis generally have reduced levels of free L-carnitine and, therefore, may be more susceptible to the development of cardiomyopathies. Studies show that L-carnitine or levocarnitine supplementation improves lipid profile, hypotension during dialysis, anemia, and skeletal myopathies. However, its possible effects on left ventricular ejection fraction and cardiac mass remain controversial.
PubMed, Embase and Cochrane were systematically searched for randomized controlled trials (RCT) comparing effects of L-carnitine or levocarnitine supplementation relative to placebo on left ventricular ejection fraction and left ventricular hypertrophy outcomes in adults. Statistical analysis was performed using Review Manager 5.4.1. Heterogeneity was assessed using the Cochran Q test and I2 statistics.
The initial search identified 133 records. After removing duplicate entries and excluding ineligible studies, 111 records remained. After applying our pre-determined inclusion and exclusion criteria, a total of 5 studies met the inclusion criteria, with a total of 284 patients who were followed over a period of 3 to 12 months of treatment, of the mentioned patients 137 (48.2%) were on L -carnitine and 147 (51.8%) were on the placebo group.
There was no significant difference between groups in left ventricular ejection fraction (MD 0.93%; 95% CI -2.15 to 4.00%) and left ventricular mass index after (MD -3.08 g/m2; 95% CI -10.29 to 4.13; p=0.40). The Levocarnitine group had an increase in total plasma in the L-carnitine group (MD 277.9 mL; 95% CI 111.4 to 444.5 mL; p=0.001).
In patients on hemodialysis, supplementation of L-carnitine or levocarnitine is associated with an increase in total plasma volume, without significant changes in left ventricular ejection fraction or left ventricular mass index.