Levocarnitine's role in the treatment of patients with end-stage renal disease: A review

In the last two decades, with successful application of new dialysis techni ques, biocompatible membranes, and erythropoietin, survival in patients wit h end-stage renal disease (ESPD) has significantly improved. However, patie nts undergoing dialysis remain debilitated and frequently exhibit symptoms that are similar to those of patients with carnitine deficiency. Levocarnit ine is a molecule required in mammalian energy metabolism. It facilitates t he transport of long-chain fatty acids into mitochondria for beta-oxidation and subsequent energy production, as well as removal of potentially toxic detergent-like acyl groups from the cell. It is essential for skeletal musc le and myocardium, which preferentially use fatty acids for their energy ne eds. Significant removal of carnitine during hemodialysis, impaired carniti ne synthesis in the liver reduced absorption from the gut, and consumption of a carnitine-poor diet have all been implicated in causing abnormal levoc arnitine metabolism in ESRD patients. Several recent studies have suggested that certain symptoms such as malaise, muscle weakness, cardiomyopathy, an d cardiac arrhythmias seen frequently inpatients with ESRD may be related t o abnormal carnitine metabolism in this patient population. Considerable ev idence suggests that supplementation with oral or intravenous levocarnitine increases carnitine concentrations in plasma and muscle, and may improve s ome of those symptoms mentioned above in dialysis patients. Intravenous lev ocarnitine has recently been approved by the Food and Drug Administration f or the prevention and treatment Of carnitine deficiency inpatients with ESR D who are undergoing dialysis.