The effects of oral L-carnitine supplementation on echocardiographic parameters in hemodialysis patients with pulmonary hypertension; a double-blind clinical trial investigation

Introduction: Hemodialysis patients face progressive reductions in carnitine levels due to the removal of carnitine during hemodialysis and decreased endogenous synthesis, which may contribute to impaired fatty acid oxidation and endothelial dysfunction, potentially playing a role in the development of pulmonary hypertension. Objectives: This study sought to assess the impact of oral L-carnitine supplementation on echocardiographic index in hemodialysis patients diagnosed with pulmonary hypertension. Patients and Methods: This double-blind, placebo-controlled, randomized clinical trial was conducted on hemodialysis patients diagnosed with pulmonary hypertension who were referred to dialysis centers in 2022, in Shahrekord, Iran. Eligible participants were randomly assigned to receive either L-carnitine or placebo for 12 weeks. Informed written consent was taken from all patients and demographic characteristics were collected. Echocardiographic parameters were measured at baseline and after the intervention, including ejection fraction, systolic pulmonary artery pressure (SPAP), mean pulmonary artery pressure (MPAP), and New York Heart Association (NYHA) functional class. Data were collected and compared between control and intervention groups using statistical tests. Results: The study included 40 participants, divided into control and intervention groups. The mean ages were 65.10 ± 8.66 years for the control group and 56.35 ± 13.76 years for the intervention group. Analysis of echocardiographic parameters revealed significant differences between the groups after three months, with the intervention group showing a notable increase in ejection fraction and significant reductions in NYHA functional class, SPAP, and MPAP compared to the control group. Conclusion: Our findings showed that L-carnitine positively impacts cardiac function and echocardiographic parameters in hemodialysis patients with pulmonary hypertension. The significant improvements in ejection fraction and reductions in the NYHA functional class, SPAP, and MPAP indicate that L-carnitine may play an effective role in enhancing cardiac performance and improving symptoms in this patient population. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20230425057989N1; https://irct.behdasht.gov.ir/trial/69751), and ethical code from Shahrekord University of Medical Sciences (Ethical code#IR.SKUMS.REC.1400.157).