Intravenous Levocarnitine Reduces Erythropoiesis-Stimulating Agent Requirements and Improves Anaemia Indices in Maintenance Haemodialysis Patients: A Prospective Cohort Study.

Abstract

Objective: To determine whether adding levocarnitine to individuals on maintenance haemodialysis lowers the need for
Erythropoiesis-stimulating agents (ESAs) while preserving hematologic control.
Methodology: This prospective observational cohort study was conducted at the Department of Nephrology, Shaikh
Zayed Hospital, Lahore, from July to December 2025. Adults on thrice-weekly hemodialysis were enrolled into an exposed
cohort receiving levocarnitine 1,000 mg intravenously after dialysis three times weekly and an unexposed cohort
receiving no levocarnitine. Both groups received recombinant human erythropoietin according to a standardized titration
protocol. Haemoglobin (Hb), hematocrit (Hct), weekly ESA dose, and erythropoietin responsiveness index (ERI = weekly
ESA dose ÷ [dry weight × average Hb]) were recorded monthly for six months.
Results: Ninety-four patients were included (47 each cohort). Baseline characteristics were generally comparable, although
controls were older, heavier, and had slightly higher baseline Hct. No clear advantage was seen at Month 1.
From Month 2 onward, levocarnitine was associated with higher Hb and Hct and lower ESA dose. By Month 6, Hb was
12.00 vs 9.77 g/dL, Hct 36.19% vs 29.29%, weekly ESA dose 7,715 vs 11,094 units, and ERI 10.07 vs 17.36 (all
p<0.0001).
Conclusion: Adjunctive levocarnitine improved erythropoiesis efficiency and reduced ESA requirements over six
months.
Keywords: anaemia; erythropoiesis-stimulating agents; erythropoietin responsiveness index; haemodialysis;
levocarnitine.