Re-evaluation of l-carnitine in chronic hemodialysis

Abstract

L-carnitine has been administered in chronic hemodialysis patients worldwide for the past decade. Although it has been shown that L-carnitine deficiency can be improved by supplementation, evidence of the beneficial effects has not been fully confirmed clinically. The reason why there are so many controversies among the clinical trials is likely to be due to the heterogeneity of the study protocols, such as the difference of dosage, administration route, duration, sample size, characteristics of subjects, reliable methods, qualified outcomes, but mainly confidence in the study itself whether it is an RCT or not. Even meta-analysis has been influenced strongly by these biases. In order to overcome these uncertainties, a highly sophisticated, large scale RCT has been suggested. However, it might be quite difficult to achieve such a trial at the moment, as Wasserstein pointed out. In this review article, we attempt to reconcile the complicated strands concerning the efficacy of l-carnitine in chronic hemodialysis patients one at a time.