American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 803-812, November 2007

Protective Effect of Intravenous Levocarnitine on Subsequent-Month Hospitalization Among Prevalent Hemodialysis Patients, 1998 to 2003

  • Eric D. Weinhandl, MS

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • Corresponding Author InformationAddress correspondence to Eric D. Weinhandl, MS, Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 S 8th St, Ste S-253, Minneapolis, MN 55404.
    • ,
  • Madhumati Rao, MD

      Affiliations

    • Tufts–New England Medical Center, Boston, MA
    • ,
  • David T. Gilbertson, PhD

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • ,
  • Allan J. Collins, MD

      Affiliations

    • Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN
    • University of Minnesota, Minneapolis, MN.
    • ,
  • Brian J.G. Pereira, MD

      Affiliations

    • Tufts–New England Medical Center, Boston, MA

Received 2 February 2007; accepted 12 July 2007. published online 17 September 2007.

Background

Levocarnitine deficiency in hemodialysis patients is common. Although the effect of intravenous levocarnitine therapy was studied in small trials, the effect on global outcomes in larger populations is unclear.

Study Design

Retrospective observational study.

Setting & Participants

Centers for Medicare & Medicaid Services data; prevalent hemodialysis patients, 1998 to 2003.

Predictor

Intravenous levocarnitine use, clinical characteristics, comorbid conditions.

Outcomes & Measurements

Effect of 1 g or greater per dialysis session of levocarnitine for 10 or more sessions during a month on subsequent hospitalization days. Repeated-measures and marginal structural models were fit, the latter to account for time-dependent confounding.

Results

Of the study population, 3% to 7% received levocarnitine for 1 month per year or more. Treated patients were older with more severe comorbidity and larger erythropoietin doses than untreated patients. In repeated-measures model analysis adjusted for demographic characteristics and disease severity, 1 g or greater per dialysis session of levocarnitine for 10 or more sessions during a month was associated with a 10.8% (95% confidence interval, 9.7 to 11.9; P < 0.01) subsequent-month decrease in hospitalization days. In marginal structural model analysis, levocarnitine therapy was associated with a 21.7% (95% confidence interval, 18.4 to 24.9; P < 0.01) decrease in hospitalization days.

Limitations

Algorithm for identifying comorbid conditions from claims validated only for diabetes; biochemical marker levels unavailable in Medicare claims; levocarnitine therapy quantified only while patients were not hospitalized.

Conclusion

Because hemodialysis patients are hospitalized about 15 days yearly, the association of monthly levocarnitine regimen with lower hospitalization rate is clinically significant. The causality of this association must be confirmed by randomized clinical trials.

Index Words: Levocarnitine, hemodialysis, hospitalization, marginal structural model

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 Because an author of this manuscript is based as Tufts-New England Medical Center, the peer-review and decision-making processes were handled entirely by an outside editor, Akinlolu Ojo, MD, PhD, University of Michigan, who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.Originally published online as doi:10.1053/j.ajkd.2007.07.017 on September 12, 2007.

PII: S0272-6386(07)01086-4

doi:10.1053/j.ajkd.2007.07.017

American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 803-812, November 2007

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