карнитин может быть полезен пожилым пациентам, но это не доказано. тиотриозолин - бесполезен
Semin Dial. 2001 May-Jun;14(3):209-17.
L-carnitine in dialysis patients.
Hemodialysis (HD) patients often have low serum concentrations of free L-carnitine and decreased skeletal muscle stores. As L-carnitine is an essential cofactor in fatty acid and energy metabolism, it is possible that abnormal carnitine metabolism in dialysis patients may be associated with clinical problems such as skeletal myopathies, intradialytic symptoms, reduced cardiac function, and anemia. Studies have shown that L-carnitine supplementation in HD patients improves several complications seen in dialysis patients, including cardiac complications (arrhythmias, reduced output, low cardiothoracic ratio), limitation of exercise capacity, increased intradialytic hypotension, and muscle symptoms. The most promising results have been noted in the treatment of erythropoietin-resistant anemia. Routine administration of L-carnitine to all dialysis patients is not recommended at this time; however, a therapeutic trial of L-carnitine can be useful in symptomatic patients with certain clinical features unresponsive to the usual measures. These include intradialytic muscle cramps and hypotension, asthenia, cardiomyopathy, lowered ejection fraction, muscle weakness or myopathy, reduced oxygen consumption, and anemia requiring large doses of EPO.
Semin Dial. 2006 Jul-Aug;19(4):323-8.
Dialysis-related carnitine disorder.
L-carnitine plays an essential role in the beta-oxidation of fatty acids by catalyzing their transport into the mitochondrial matrix. The kidney maintains plasma free L-carnitine levels in the homeostatic range by selective saturable tubular reabsorption. The preferential retention of free L-carnitine over acyl-L-carnitines by the kidney is lost in patients with end-stage renal disease (ESRD). Loss of renal parenchyma as a site of carnitine synthesis, as well as nonselective clearance of L-carnitine by the dialysis procedure lead to dialysis-related carnitine deficiency. Numerous studies investigating whether L-carnitine supplementation will alleviate several dialysis-related symptoms, such as intradialytic hypotension, heart failure, muscle weakness, low exercise capacity, and anemia, have reported conflicting results. Many of these studies suffer from a lack of randomization and control groups, heterogeneity in the administration of L-carnitine, and nonstandardized measures of symptom improvement. More data exist to support the use of L-carnitine in selected anemic dialysis patients with very large erythropoietin requirements in whom extensive examination for reversible causes of anemia was unrevealing.
из UpToDate: CARNITINE SUPPLEMENTATION IN DIALYSIS PATIENTS — It is difficult to clearly ascribe benefits with L-carnitine supplementation in dialysis patients because of the following:
●The symptoms of carnitine deficiency (including muscle weakness and cardiomyopathy) overlap with those of dialysis patients generally.
●Laboratory evidence of abnormal carnitine metabolism is ubiquitous in this population.
●The response to carnitine supplementation cannot be predicted from plasma carnitine profiles.
There are numerous studies supporting the view that L-carnitine supplementation improves the plasma lipid profile, exercise capacity and oxygen utilization, muscle strength, intradialytic symptoms, sense of well-being, hospitalization rate, inflammatory markers, protein metabolism, left ventricular hypertrophy and cardiac function, anemia, and response to erythropoietin. In many of these instances, the physiologic rationale for administration of L-carnitine is appealing.
However, data evaluating these possible benefits of L-carnitine supplementation in hemodialysis patients are limited, with many trials being uncontrolled and small in size. Although some controlled, prospective studies have been performed, trials have been limited by small size, inclusion of patients independent of signs and symptoms of carnitine deficiency, and relatively short follow-up [8,9].
In general, a growing literature supports benefits with L-carnitine supplementation on inflammation and muscle wasting. However, the evidence is unclear that L-carnitine supplementation in dialysis patients improves exercise capacity, cardiomyopathy, or intradialytic symptoms.