Effect of Hemodialysis on carnitine Level in Children with Chronic Renal Failure

ABSTRACT
Background: Levocarnitine is a molecule required in mammalian energy metabolism, it removes the potentially toxic acyl groups from the cell helping to maintain normal metabolic functions. Objectives: The aim of this work is to study serum carnitine levels in children with end-stage renal failure and the effect of conservative management and regular hemodialysis on this level. Methods: This study included 10 children with end-stage renal disease under conservative management (4 males and 6 females), 20 children with end-stage renal disease under regular hemodialysis (6 males and 14 females), and 10 apparently healthy control children (5 males and 5 females).All groups were age matched. All patients were subjected to complete history taking, thorough clinical examination and ECHO. In the third group full history of dialysis duration, number of sessions, duration of each session, size of filter used and type of filter were taken. Laboratory investigations were done including complete blood picture, blood urea, serum creatinine, sodium, potassium, phosphorous, and albumin level in serum. Serum creatinine level was done all subjects, one sample from the control group and from patients under conservative management and three samples from patients under regular hemodialysis: predialysis, immediately postdialysis and 1 hour postdialysis. Results: We found that serum level of creatinine in the healthy group was 9.8 ± 1.5mg/I, while in patients with chronic renal failure under conservative management the serum carnitine level was 1.3 ± 1.2 mg/I and serum carnitine level of patients with chronic renal failure under regular hemodialysis was 3.98 ± 1.94 mg/I. There was no correlation to size of filter. We found that serum carnitine level was not significantly lower with filters of polysulphone with a level of 3.4 ± 1.4 mg/I, than cuprophane with a level of 4.6 ± 2.3 mg/I. There was a positive correlation between serum carnitine level and duration of the disease. We found that the predialysis basal level (3.98 ± 1.94 mg/I), was highly significantly lower immediately postdialysis (1.35 ± 0.94 mg/I) and starts rising but still remained less than basal level 1 hour postdiaysis (2.16 ± 1.15 mg/I). Conclusions: We concluded that children with end-stage renal disease have a lower serum level of carnitine than age matched healthy children. Children under conservative management may have a lower level than those on regular hemodialysis. Serum carnitine level decrease rapidly  during hemodialysis and started to rise to a level near the predialysis basal level 1 hour after the hemodialysis session. So, we recommend measurement of serum carnitine level in all children with end-stage renal disease either on conservative management or on regular hemodialysis to detect the deficiency as early as possible. Supplementation of patients on conservative management with iron and vitamin B complex and amino acids should be done to ensure carnitine synthesis.