L-carnitine in uremic anemia

Anemia, defined as a qualitative or quantitative deficiency of hemoglobin, is a frequent and serious complication of chronic kidney disease (CKD). Deficient erythropoietin synthesis, iron deficiency, blood loss, and a decreased erythrocyte half-life are the main contributors to anemia associated with CKD. Anemia in CKD patients contributes to many of the symptoms associated with the disease, including fatigue, depression, reduced tolerance of exercise, dyspnea, cardiovascular consequences such as left ventricular hypertrophy and left ventricular systolic dysfunction, and increased risk of mortality. The introduction of erythropoietin analogues, also termed erythropoiesis stimulating agents (ESAs), has revolutionized the care of renal anemia patients. Today ESAs and iron therapy are the main tools for treating anemia associated with CKD. The available ESAs are generally very effective drugs, and real resistance to their action is rarely seen. However, several factors can cause incomplete response to ESA: recognition and correction of these may improve anemia management. If there are no correctable underlying causes or deficiency states limiting erythropoiesis, in patients with poor response or needing high ESA doses adjuvant therapies may be employed to increase the hemoglobin level and improve ESA cost/efficacy. Adjuvant therapies for renal anemia include the naturally occurring compound L-carnitine. Here, we here review the evidence available for L-carnitine treatment in dialysis patients suffering from uremic anemia.