Abstract: FR-PO0550
Evaluation of Levocarnitine Use in Pediatric Patients Undergoing Peritoneal Dialysis
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Mahmud, Sanaa, SickKids Research Institute, Toronto, Ontario, Canada
- Aquilina, Andrea, The Hospital for Sick Children Division of Nephrology, Toronto, Ontario, Canada
- Licht, Christoph, SickKids Research Institute, Toronto, Ontario, Canada
- Bruno, Valentina, SickKids Research Institute, Toronto, Ontario, Canada
- Tjon, James Anthony, The Hospital for Sick Children Division of Nephrology, Toronto, Ontario, Canada
Background
Patients with ESRD undergoing peritoneal dialysis (PD) experience significant L-carnitine loss, altering acyl/free carnitine ratio (AFCR). Secondary carnitine deficiency manifests in clinical complications such as EPO-resistant anemia, intradialytic hypotension, cardiomyopathy, and skeletal muscle weakness. The efficacy of L-carnitine supplementation in reversing deficiency remains unclear and few studies have evaluated its use in PD, limiting evidence-based recommendations. This quality improvement study investigated L-carnitine supplementation in the pediatric PD population.
Methods
Retrospective chart review (2018–2024) was completed for 20 PD patients (2–17 years) receiving intraperitoneal L-carnitine in varying monthly doses (500 mg, 750 mg, or 1000 mg). Patients were evaluated pre-treatment, monthly during treatment, and post-treatment at their final visit. Carnitine deficiency was defined as AFCR>0.4. The primary outcome was correction of AFCR, classified as ‘improvement’ and measured by a lower post-treatment AFCR compared to pre-treatment. Secondary outcomes included anemia presence measured by hemoglobin levels and erythropoietin-stimulating agent (ESA) doses. Statistical analyses included one-way ANOVA, t-tests, and Chi-Squared tests.
Results
9/20 patients (45%) showed improvement, 10/20 (50%) worsened as seen by increased AFCR, and 1 (5%) showed no change (p=0.8). Mean duration of treatment was 13.7±7.7 months and was significantly associated with improvement (p<0.001). Improved patients received similar mean L-carnitine (28.8 vs 20.7mg/kg) and ESA doses to worsened patients (p=0.2, p=0.8, p=0.4). An association between L-carnitine dose and post-AFCR was seen (p<0.001), as well as a significant decrease between pre- and post-AFCR in improved patients (p=0.003). Age was associated with L-carnitine dose and improvement, whereby patients ages <=10 years received higher weight-adjusted doses than patients ages 11-17 (p=0.09). Treatment duration was strongly associated with hemoglobin levels in all patients (p<0.001).
Conclusion
L-carnitine supplementation in higher doses and for longer duration was associated with improvement in 45% of patients, as evidenced by lower post-treatment AFCRs. Further research and larger sample size are required to determine whether correction of AFCR is beneficial against associated complications.