Abstract: Objective To observe different L-carnitine doses for patients on maintenance hemodialysis (MHD) complicated with heart failure. Methods This prospective study enrolled 44 patients on MHD for chronic renal failure and complicated with heart failure. They were treated with continuous renal replacement therapy (CRRT) at bedside and intravenous injection of L-carnitine for hear failure. They were randomly divided into 2 groups based on L-carnitine dose. Patients in groupA were treated with higher L-carnitine dose (2g L-carnitine in 20 ml 0.9% NaCl intravenously per day for 14 days); those in group B were treated with routine L-carnitine dose at the end of CRRT (1g L-carnitine in 0.9% NaCl intravenously per day for 14 days). Brain natriuretic peptide (BNP) and cardiac structure and function by echocardiography were examined before and after the treatment. Results In group A after the treatment, left ventricular end-diastolic diameter (t= 6.382, P＜0.001) and end-systolic diameter (t=3.174, P=0.003) decresed, left ventricular ejection fraction (t= 2.978, P=0.007) increased, and BNP decreased (t=- 3.489, P=0.001). In group B after the treatment, blood BNP decreased (t=6.125, P＜0.001), left ventricular ejection fraction increased (t=-2.324, P=0.037); left ventricular end-systolic volume (t=1.401, P=0.115) and left ventricular end-diastolic volume (t=1.799, P=0.062) decreased but without statisitcal significance. When comparison was made between group A and group B, BNP (t=2.699, P=0.023), left ventricular end- diastolic volume (t=2.332, P=0.031), and left ventricular endsystolic volume (t=2.713, P=0.012) decreased more in group A than in group B, while left ventricular ejection fraction (t=2.224, P=0.042) increased more in groupA than in group B. Eventually, the patients back to the routine hemodialysis department were more in group A than in group B (χ²=4.041, P=0.044). Conclusion Higher L-carnitine dose combined with CRRT were effective in a shorter period time to promote heart fuctions and left ventricular remodeling, to reduce clinical adverse events, and to improve prognosis in MHD patients with heart failure.

Key words: L-carnitine, Maintenance hemodialysis, Chronic heart failure, Cardiac structure and function