Abstract
Anemia is a common complication associated with hemodialysis and is usually managed by treatment with erythropoiesis-stimulating agent (ESA). However, some patients remain hyporesponsive to a high dose of ESA despite adequate iron therapy. Reduced free carnitine and elevated acylcarnitine have been implicated as factors potentially contributing to ESA hyporesponsiveness in some cases. Decrease in free carnitine (27.2 μmol/L) and increase in acylcarnitine/free carnitine ratio (0.42) were observed in a 77-year-old male maintenance hemodialysis patient. Supplementation of L-carnitine at 600 mg/day remarkably improved the hyporesponsiveness to ESA. The patient's hemoglobin level increased gradually after six months of L-carnitine supplementation (8.5±0.73 to 9.7±0.43 g/dL). The patient's hemoglobin level remained stable (11.52±0.51 g/dL) for up to eighteen months of L-carnitine therapy. Weekly ESA (Darbepoetin alfa) dose administration decreased considerably, from 1.1 μg/kg/week to 0.52 μg/kg/week.
