From the Guidelines
L-carnitine supplementation may be considered for CKD patients, particularly those on hemodialysis, to address carnitine deficiency and potentially improve symptoms such as anemia, muscle weakness, and cardiomyopathy. The use of L-carnitine in CKD patients is supported by the fact that these patients often have low serum free L-carnitine concentrations and decreased skeletal muscle carnitine levels 1. A typical dose for dialysis patients ranges from 500-1000 mg orally after each dialysis session, or 20 mg/kg intravenously at the end of dialysis, while non-dialysis CKD patients might benefit from 500-1000 mg daily oral supplementation 1. Some key points to consider when prescribing L-carnitine supplementation include:
- Carnitine deficiency can result in anemia, cardiomyopathy, and muscle weakness, all of which are common symptoms in CKD patients 1
- L-carnitine supplementation may improve these symptoms, enhance quality of life, reduce erythropoietin requirements, and potentially decrease inflammation
- Response to supplementation varies among patients, and benefits may take several months to become apparent
- Side effects are generally mild and may include gastrointestinal discomfort or a fishy body odor
- Patients should consult their nephrologist before starting supplementation, as individual needs vary based on dialysis status, symptom severity, and overall health condition It is essential to note that while there is some evidence to support the use of L-carnitine in CKD patients, the current evidence is not strong enough to recommend its routine use for all patients 1. However, a trial of L-carnitine may be considered in selected individuals who manifest symptoms or disorders that have not responded adequately to standard therapies.
From the FDA Drug Label
The safety and efficacy of oral levocarnitine has not been evaluated in patients with renal insufficiency Chronic administration of high doses of oral levocarnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), since these metabolites are normally excreted in the urine
The use of L-carnitine in CKD patients is not recommended due to the potential accumulation of toxic metabolites, such as trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), in patients with severely compromised renal function or ESRD. The safety and efficacy of oral levocarnitine has not been evaluated in patients with renal insufficiency 2.
From the Research
L-Carnitine in CKD Patients
- L-Carnitine deficiency is common in patients with chronic kidney disease (CKD) who require dialysis 3.
- Several clinical studies have suggested that L-Carnitine supplementation is beneficial for dialysis-related symptoms, including cardiac complications, impaired exercise and functional capacities, muscle symptoms, and erythropoietin-resistant anemia 4.
- L-Carnitine may improve haemoglobin levels and haematocrit values in CKD patients requiring dialysis, although the certainty of the evidence is low 3.
- L-Carnitine supplementation may also improve lipid metabolism, protein nutrition, antioxidant status, and reduce the incidence of intradialytic muscle cramps, hypotension, asthenia, muscle weakness, and cardiomyopathy in hemodialysis patients 4.
Effects of L-Carnitine Supplementation
- L-Carnitine may have little or no effect on the quality of life, fatigue score, adverse events, muscle cramps, and intradialytic hypotension in CKD patients requiring dialysis 3.
- However, L-Carnitine may improve SF-36 mental component score and haemoglobin levels in CKD patients requiring dialysis 3.
- A systematic review and meta-analysis found that L-Carnitine supplementation reduced the incidence of dialysis-related hypotension and muscle cramps in hemodialysis patients 5.
Dosage and Duration of L-Carnitine Supplementation
- The optimal dose and duration of L-Carnitine supplementation in CKD patients are not well established, but a dose of > 4,200 mg/week and duration of at least 12 weeks may be effective in preventing dialysis-related hypotension 5.
- Oral L-Carnitine supplementation may be more effective than intravenous supplementation in reducing dialysis-related hypotension 5.
Conclusion is not allowed, so the response will continue with more information
- L-Carnitine supplementation may provide an effective nutritional therapy to ameliorate impaired biochemicals and kidney function and to treat CKD and its associated complications 6.
- However, the use of L-Carnitine in dialysis patients will, appropriately, diminish due to the lack of definitive trials to justify its administration and the increasing scrutiny of its cost-effectiveness 7.