الفهرس 
PROTEIN-ENERGY MALNUTRITIONOnly 14 pages are availabe for public view
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Abstract
Carnitine deficiency is known to develop in patients receiving
hemodialysis, and may contribute to a number of clinical conditions,
including cachexia, erythropoiesis stimulating agent-resistant anemia,
myasthenia, insulin resistance, and myopathy, as well as intradialytic
symptoms, including muscle cramps, hypotension, and arrhythmias.
Protein-energy wasting (PEW) is common in patients with endstage renal disease on maintenance dialysis and is associated with
increased morbidity and mortality. Protein-energy malnutrition (PEW) is
common in patients with chronic kidney disease (CKD), especially in
those undergoing chronic hemodialysis (HD), being an important
predictor of morbidity and mortality in this population.
Although inadequate food intake contributes to this condition, there
are other characteristics of the syndrome that cannot be explained only by
anorexia, such as the inflammation affecting this population.
The malnutrition-inflammation score (MIS) was developed from
the Global Subjective Assessment (SGA), using the close relationship
between malnutrition and inflammation among dialysis patients. In
addition, higher MIS scores are associated with a higher risk of death and
hospitalizations in HD patients.
Despite these advantages, one of the MIS limitations is the low
practicality for monitoring dialysis patients, since it uses subjective
parameters, which require the evaluator‘s experience, and depends on
data that may not be available at a certain time.Handgrip strength (HGS) has stood out as a method of assessing
nutritional status, and it is feasible in clinical practice. Still, since it is a
test for measuring voluntary muscle strength, it is strongly correlated to
body mass, making it possible to identify patients who had a significant
reduction in nutritional status before any change occurred. In the
scientific literature, few studies have evaluated HGS as a parameter for
nutritional assessment in hemodialysis patients, and they used different
measurement methods.
L-carnitine is an essential compound that facilitates the transport of
long-chain fatty acid across the inner mitochondrial membrane for βoxidation. However, the effect of L-carnitine supplementation remains to
be fully explored in patients with chronic kidney disease.
Dialysis patients are especially at high risk for carnitine deficiency
due to poor intake of sources of dietary carnitine such as red meat,
reduced biosynthesis in the kidneys, and diffusive loss from the dialysate.
In incident hemodialysis (HD) patients, the plasma carnitine level
decreases within the first week of the treatment, with a continual decrease
over the first 12 months of treatment.
The carnitine content of the skeletal muscle also decreases in
hemodialysis patients and is inversely correlated with time on HD.
Metabolism of skeletal muscle is carnitine-dependent because fatty acid
oxidation is the main source of energy in the muscular cells. However, it
remains to be fully determined whether or not L-carnitine
supplementation improves muscle power, physical capacity, and
muscular symptoms.The main aim of this study was to study the effect of L-carnitine
supplementation on handgrip strength as an assessment of the nutritional
status in hemodialysis patients.
This was a simple random sample computer generated study was
conducted in Hemodialysis unit in Nephrology department - Ain Shams
university hospital in the period of January 2021 to march 2021. The
study included 100 hemodialysis patients.
The main findings of the study revealed that:
There was no statistical significant difference between the two
studied groups as regard demographic data.
There was no statistical significant difference between the two
studied groups as regard SGA items.
There was no statistical significant difference between the two
studied groups as regard SGA rating.
There was no statistical significant difference between the two
studied groups as regard anthropometrics.
There was no statistically significant difference between the two
studied groups as regard hand grip strength score.
There was statistically significant difference between the two
studied groups as regard urea. There was no statistically significant
difference between the two studied groups as regard albumin.
Among group A; there was statistical high significant difference
between the two studied groups (pre and post) as regard findings
(e.g.; carnitine, hand grip strength score). Among group B; there
was statistical high significant difference between the two studied
groups (pre and post) as regard findings (e.g.; carnitine, hand grip
strength score).
There was no statistically significant difference between the two
studied groups as regard nPCR. Among group A; there was no
significant correlation between nPCR and BMI, TSFT& MAC.
There was significant correlation between nPCR and HGSS.
Among group B; there was no significant correlation between
nPCR and BMI, TSFT, MAC & HGSS.Based on our findings, we recommend for further studies on larger
sample size and on large geographical scale to emphasize our conclusion.