Abstract
Substitution therapy using levocarnitine chloride (L-carnitine 600 mg/day, 12 weeks) was carried out in 13 cases of hemodialysis patients requiring high-capacity (9,000 IU/week or more upon rHuEpo conversion) ESA, and its effect against anemia was investigated along with the ESA requirement. The TC and FC values were very low in all patients before levocarnitine administration, and increased to a normal range 4 weeks after the administration and continued to increase over the following 12 weeks. The hemoglobin value increased by 1.0 g/dL or more in 7 of the 13 cases due to levocarnitine administration, while ESA was reduced by 25% or more in 4 cases, and was effective in a total of 9 cases (2 cases satisfying both standards). There were no significant differences between the effective example and ineffective example regarding the TC, FC, and acylcarnitine (AC) values as well as FC/AC ratio prior to levocarnitine administration. The TC and FC values 4 and 12 weeks after administration in the effective example were significantly higher than those in the ineffective example. The FC/AC ratio significantly increased in the effective example 4 and 8 weeks after administration compared with the prior value. Although red blood cell survival was shortened in 3 effective examples prior to administration, this improved following administration. Red blood cell survival in 2 ineffective examples did not improve, even after administration. As a result, levocarnitine substitution therapy appears to be highly effective in anemic hemodialysis patients without complicated diseases requiring high-quantity ESA, and its mechanism of action is mainly the improvement of shortened red blood cell survival.
