A case of successful management of a hemodialysis patient with levocarnitine

Abstract

We present a case of a patient with end-stage renal disease maintained on hemodialysis, who was managed successfully by oral levocarnitine treatment. The patient was a 58-year-old male who was started on hemodialysis for end-stage renal disease secondary to diabetic nephropathy in April 2008. Echocardiography revealed systolic and diastolic dysfunction with EF of 48.9% and E/e’ of 19.5 and severe left ventricular hypertrophy (LMVI 151 g/m²). rHuEPO was administered subcutaneously at 9,000 IU/week. Because the ESA resistance index (ERI), calculated as the weekly weight-adjusted dose of EPO divided by the hemoglobin level (rHuEPO doses/kg/g/dL/week), was relatively high (13.5), oral levocarnitine therapy (1,200 mg/day) was started. At 1 year of therapy, echocardiographic parameters improved with EF of 72.7% and LVMI of 107 g/m². NT-proBNP decreased from 12,800 pg/mL to 7,850 pg/mL. The dose of rHuEPO could be reduced from 9,000 U/week to 3,000 U/week and ERI decreased markedly from 13.5 to 3.9. Brachial-ankle pulse wave velocity (baPWV) as an arteriosclerotic indicator decreased from 1,832 cm/sec to 1,545 cm/sec. Arm muscle area (AMA) increased from 32.9 cm² to 39.3 cm². ALT and AST decreased slightly from 12 U/L to 9 U/L and from 14/U to 9 U/L, respectively.