Effects of L-carnitine on arrhythmias during hemodialysis

The therapeutic effect of L-carnitine on arrhythmias during hemodialysis was evaluated in 17 patients with chronic renal disease undergoing intermittent hemodialysis. In 11 of 17 patients (65%), ventricular or supraventricular premature beats appeared at 20 to 30 min after the start of hemodialysis and continued throughout the dialysis. Plasma carnitine was at a lower level in the predialysis period (24.8 +/- 7.9 n mole/ml) as compared with the normal human levels (46.1 +/- 8.6 n mole/ml), and decreased markedly by the end of dialysis (8.2 +/- 5.9 n mole/ml). Plasma free fatty acids rapidly increased immediately after the start of dialysis, reached the maximum levels after 20 min (from 0.23 +/- 0.09 to 1.31 +/- 0.64 mEq/L) and maintained higher levels even at the end of dialysis (0.76 +/- 0.29 mEq/L). Administration of L-carnitine (2 Gm orally), 2 hours before the start of dialysis maintained plasma carnitine within normal levels throughout the dialysis and suppressed the increase in plasma free fatty acids. Both the incidence and the severity of premature beats during hemodialysis were significantly reduced by oral administration of L-carnitine (2 Gm daily) for 4 to 8 weeks. These results suggest that L-carnitine is useful for the treatment of hemodialysis arrhythmias, presumably by restoring impaired oxidation of free fatty acids.