Carnitine, Aclycarnitine, Myocardial Function, and CRRT
| Status: | Recruiting |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Cardiology, Neurology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Nephrology / Urology, Neurology |
| Healthy: | No |
| Age Range: | 1 - 21 |
| Updated: | 2/1/2019 |
| Start Date: | December 2014 |
| End Date: | January 2020 |
| Contact: | Asha Moudgil, MD |
| Email: | amoudgil@cnmc.org |
Pilot Study: Effect of Carnitine Supplementation on Acylcarnitine Profile and Myocardial Function in Children and Young Adults Receiving Continuous Renal Replacement Therapy
Carnitine is essential for the transport of fatty acids into the mitochondria and energy
production in different muscles, including the myocardium. It is also needed to protect
myocyte cell membranes from oxidative damage by removing excess acyl carnitine groups.
Patients receiving chronic intermittent hemodialysis (HD) are known to be at increased risk
for carnitine deficiency as a result of its removal during the dialysis procedure, lack of
endogenous synthesis by the kidney, and inadequate dietary intake. The carnitine status of
children undergoing continuous renal replacement therapy (CRRT) has not been studied.
Children undergoing CRRT in the intensive care unit (ICU) setting may be at increased risk
for carnitine deficiency due to its continuous removal, lack of carnitine production by the
kidney, and absence of carnitine intake (as majority of these children can not eat and there
is no carnitine added to total parenteral nutrition (TPN). Carnitine deficiency may increase
the risk of cardiac dysfunction in critically ill children. This is the first study to
examine carnitine status in children undergoing CRRT. Standard echo as well as more sensitive
speckle tracking echo will be used to evaluate the effect of carnitine deficiency on
myocardial function.
production in different muscles, including the myocardium. It is also needed to protect
myocyte cell membranes from oxidative damage by removing excess acyl carnitine groups.
Patients receiving chronic intermittent hemodialysis (HD) are known to be at increased risk
for carnitine deficiency as a result of its removal during the dialysis procedure, lack of
endogenous synthesis by the kidney, and inadequate dietary intake. The carnitine status of
children undergoing continuous renal replacement therapy (CRRT) has not been studied.
Children undergoing CRRT in the intensive care unit (ICU) setting may be at increased risk
for carnitine deficiency due to its continuous removal, lack of carnitine production by the
kidney, and absence of carnitine intake (as majority of these children can not eat and there
is no carnitine added to total parenteral nutrition (TPN). Carnitine deficiency may increase
the risk of cardiac dysfunction in critically ill children. This is the first study to
examine carnitine status in children undergoing CRRT. Standard echo as well as more sensitive
speckle tracking echo will be used to evaluate the effect of carnitine deficiency on
myocardial function.
Study Design:The research design consists of a prospective study group that would be compared
to two control groups (a prospective control groups and a retrospective control group). The
study group will consist of critically ill children receiving CRRT and IV carnitine
supplementation (added in the TPN). The prospective control group will consist of critically
ill children not receiving CRRT or carnitine Retrospective control group will consist of
critically ill children who received CRRT but did not receive carnitine supplementation. .
Subjects for the prospective study and control groups will be recruited from the pediatric
intensive care unit (PICU) and the cardiac intensive care unit (CICU) at Children's National.
Informed consent will be obtained from participants enrolled in the prospective study and
control groups. Data for the retrospective control group will be obtained from the medical
record.
to two control groups (a prospective control groups and a retrospective control group). The
study group will consist of critically ill children receiving CRRT and IV carnitine
supplementation (added in the TPN). The prospective control group will consist of critically
ill children not receiving CRRT or carnitine Retrospective control group will consist of
critically ill children who received CRRT but did not receive carnitine supplementation. .
Subjects for the prospective study and control groups will be recruited from the pediatric
intensive care unit (PICU) and the cardiac intensive care unit (CICU) at Children's National.
Informed consent will be obtained from participants enrolled in the prospective study and
control groups. Data for the retrospective control group will be obtained from the medical
record.
Patients
CRRT Study Group (n=10) Inclusion Criteria
1. age 1-21 years
2. Receiving CRRT in the PICU or CICU
3. NPO or TPN-dependent Exclusion Criteria
1. Children on chronic dialysis 4. Children on carnitine supplementation for a metabolic
disorder 5. Children on CRRT for less than 1 week
Prospective Control Group (n=10) Inclusion Criteria 1. age 1-21years 2. Receiving care in
the PICU or CICU, but not requiring CRRT 3. NPO or TPN-dependent Exclusion Criteria
1. Children on chronic dialysis
2. Children on carnitine supplementation for a metabolic disorder
Retrospective CRRT Control Group (n=10) Inclusion Criteria
1. 1-21years of age
2. Received CRRT between 2011-2015
3. Had total and free carnitine level checked while on CRRT (2 values>1 week apart)
4. Had echocardiogram (2 studies >1 week apart) Exclusion Criteria
1. Receiving supplemental carnitine at time of carnitine level and/or echocardiogram 2.
Congenital or acute heart disease 3. On ECMO
We found this trial at
1
site
Washington, District of Columbia 20010
Principal Investigator: Asha Moudgil, MD
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