Who is at Risk?

Patients with End-Stage Renal Disease (ESRD)

Normally, 75% of a person's carnitine needs are met through his or her diet. However, ESRD patients are on a restricted diet and may not get the carnitine they need from food. Certain foods such as meat and dairy products are high in carnitine.

And, normally, 25% of a person's carnitine needs are met by the natural production of carnitine in the liver and kidneys. But without properly functioning organs, this supply of carnitine is cut off as well.

Most important, the dialysis process itself removes carnitine from the bloodstream as shown in the following figures.

Dialysis removes approximately 75% of free carnitine from plasma during each session. (normal level is 40-50 µmol/L)

Evans et al: Pharmacokinetics of L-carnitine in patients with end-stage renal disease undergoing long-term hemodialysis. Clin Pharmacol Ther 68:238-249, 2000

In patients on dialysis for more than 6 months, 95% have below normal plasma concentrations of free carnitine (less than 40 µmol/L)

Fornasini G, Evans A: Analysis of Free Carnitine in Plasma of ESRD Patients Undergoing Chronic Dialysis: What is the Best Assay. Dialysis & Transplantation 2003;32:S1–S12