L-carnitine as an Adjunct Treatment for Septic Shock Patients With Acute Kidney Injury

L-carnitine as an Adjunct Treatment for Septic Shock Patients With Acute Kidney Injury: a Multicentre, Randomized, 2-parallel Group, Superiority Trial

The primary objective of this study is to compare 28 day mortality rates between septic shock patients with acute renal insufficiency treated via L-Carnitine (as an adjunct therapy) versus a similar group of patients not receiving L-Carnitine adjunct therapy.

The secondary objectives of this study are:

A. First secondary objective of this study is to compare 10 day mortality rates of septic shock patients with renal insufficiency treated via L-Carnitine (as an adjunct therapy) for 56 days versus a patients not receiving L-Carnitine adjunct therapy

B. To compare study arms in terms of patient safety.

C. To compare study arms in terms of further clinical outcomes, with special emphasis on nephrological outcomes.

D. To study (and compare between arms) the kinetic curves of free and total serum carnitine. Renal replacement therapy rapidly depletes the body's carnitine levels. Tracking adequate carnitine levels is therefore important for the interpretation of study results.

E. To constitute a bio-bank in association with the study for future ancillary studies (e.g. kidney injury marker studies, carnitine-responders versus non-responders, and other exploratory studies.

Inclusion Criteria:

• • The emergency inclusion procedure was correctly applied according to French law (signature of consent form by a patient-designated trusted person or a family member, or a medical decision to proceed with patient inclusion if the latter two persons are unavailable) ---- OR ---- signature of the consent form by the patient

  • The patient must be insured or beneficiary of a health insurance plan
  • The patient is at least 18 years old
  • The patient was admitted to an intensive care unit (participating in the study) for sepsis or septic shock and presented with acute renal failure requiring, at some point, the use of extra-renal purification.
  • • The patient has sepsis or septic shock according to international criteria SEPSIS 3 (Singer et al, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) ; JAMA. 2016)
  • The patient has acute renal insufficiency with an KDIGO score of 3
  • The patient has started continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT) within the previous 72 hours, or will start RRT (CRRT or IRRT) within the next 72 hours.

Exclusion Criteria:

• • The patient is participating in, or has participated in over the past three months, another interventional study that may interfere with the results or conclusions of this study

  • The patient is in an exclusion period determined by a previous study
  • The patient is under judicial protection, or is an adult under guardianship
  • The patient is pregnant, parturient or breastfeeding
  • The patient is susceptible to procreate and does not use methods of effective contraception (contraceptive hormonal ring, surgical contraception, contraceptive implant, contraceptive pill, male or female sheaths, skin patch, intrauterine contraceptive device)
  • If the patient is unable to sign a consent form: the patient-designated trusted person or family member refuses to sign the consent form
  • If the patient is unable to sign a consent form: It is impossible to correctly inform the patient-designated trusted person or family member
  • The patient is able/apt to sign a consent form, but refuses to do so
  • The patient is able/apt to sign a consent form, but cannot be correctly informed
  • Septic shock without associated AKI
  • Patients with a known allergy to L-Carnitine or other component of levocarnil oral solution or for injection
  • Pre-existing chronic disease requiring dialysis
  • The patient has stage 4 CKD with baseline DFG (CDK) if known <30 ml
  • History of seizures or epilepsy
  • Chronic bowel disease or history of chronic diarrhoea
  • Under treatment with sodium valproate