Levocarnitine Injections Decrease the Need for Erythropoiesis-Stimulating Agents in Hemodialysis Patients with Renal Anemia

Abstract

Aims: The aim of this study was to evaluate the efficacy of levocarnitine injection for renal anemia in hemodialysis patients. Methods: In this randomized controlled clinical trial, we randomly assigned patients on maintenance hemodialysis at our hospital to receive levocarnitine injections (n = 30) or no injection (n = 30) and monitored the patients during 12 months of treatment. In the treatment group, patients received an injection of levocarnitine 1,000 mg 3 times weekly after hemodialysis sessions. All patients received recombinant human erythropoietin as an erythropoiesis-stimulating agent (ESA). Response to ESA therapy was determined by calculating the erythropoietin responsiveness index (ERI; ESA dose·kg^-1·g^-1· dL^-1·week^-1). Results: (1) The target levels of hemoglobin and hematocrit were maintained during the study period in both the levocarnitine group and the control group. (2) The dose of ESAs required to maintain these levels decreased gradually in the levocarnitine group and was significantly lower at 6 and 12 months than at study initiation. Furthermore, the dose of ESAs was significantly lower than that in the control group at 12 months. (3) The ERI showed a significant decrease at 6 and 12 months in the levocarnitine group, with a significant difference between the 2 groups at 12 months. Conclusion: Our results suggest that levocarnitine administration can reduce the dose of ESAs required in patients with renal anemia on hemodialysis and improve the response to ESA therapy.

Ferric Citrate Decreases Fibroblast Growth Factor 23 and Improves Erythropoietin Responsiveness in Hemodialysis Patients

“…The mean dose of saccharated ferric oxide at baseline and at the end of the study was defined as follows: the mean dose of saccharated ferric oxide per 4 weeks during the 12 weeks before the study period was defined as baseline level and mean dose of saccharated ferric oxide per 4 weeks during the study period was defined as the end of the study. Erythropoietin responsiveness index (ERI) was defined as the average weekly ESA dose divided by clinical dry weight and average blood hemoglobin (weekly ESA dose [units]/dry weight [kg]/hemoglobin [g/dL]) as described previously [14, 15] to normalize the amount of required ESA to the severity of anemia. These variables were evaluated at baseline and at 24 weeks (at the end of the study).…”

Prevalence of Carnitine Deficiency and Decreased Carnitine Levels in Patients on Hemodialysis

“…Patients on hemodialysis (HD) are known to develop carnitine deficiency [1][2][3]. This deficiency may contribute to a number of clinical disorders, including cachexia, dyslipidemia, erythropoiesis stimulating agent-resistant anemia, insulin resistance and glucose intolerance, muscle weakness, and myopathy, as well as intradialytic symptoms, such as muscle cramps, hypotension, and cardiac arrhythmia [4,5].…”

Effect of L-Carnitine on Amino Acid Metabolism in Elderly Patients Undergoing Regular Hemodialysis

“…Maruyama et al [16] reported that L-carnitine treatment reduced the required dose of ESAs in patients with a mean age of 70 ± 10 years having renal anemia on hemodialysis; it also maintained lean body mass and hand grip strength in hemodialysis patients [17]. We also evaluated the patients with similar age distribution, and although not significant, ERI was likely to decrease following L-carnitine treatment.…”