L‐Carnitine Administration to Hemodialysis Patients: Has Its Time Come?

L-Carnitine facilitates the entry of long-chain fatty acids into mitochondria, where they are oxidized, producing energy for muscles and other cells. The pharmacology, pharmacokinetics, and metabolism of L-carnitine have recently been reviewed in normal humans and in patients with renal insufficiency and on dialysis ( 1-6). It is synthesized mainly in the liver, brain, and kidneys, while meat and dairy products are rich dietary sources. Losses during the dialysis procedure increase the propensity for deficiency and/or depletion (3, 4, 71 1). Insufficient carnitine may lead to fatty acid accumulation, which has toxic effects on cell function and may create an energy deficit within cells (2). Certain clinical conditions that are common in dialysis patients may be related to abnormalities of carnitine metabolism (3), including skeletal myopathy, cardiomyopathy, arrhythmias, and plasma lipid abnormalities. Some intradialytic symptoms such as muscle cramps, cardiac arrhythmias, and hypotension may also be related to carnitine metabolism. It is the purpose of this editorial to review the data regarding the efficacy of L-carnitine supplementation in the correction of these disorders in chronic hemodialysis (HD) patients and to suggest appropriate therapeutic regimens.