Saving erythropoietin by administering L-carnitine?

have been reported by several authors [2,3,6 ]. The Introduction high total serum concentration of carnitine results predominantly from an increase in -carnitine esters, Recombinant human erythropoietin (rhEpo) is widely i.e. acylcarnitine. As a result of the reduction in free used for correction of anaemia in patients with endcarnitine, the ratios of free/total carnitine and free stage renal disease (ESRD). In some countries, the carnitine/acylcarnitine are decreased in dialysis patients cost of rhEpo treatment accounts for up to 10% of [9]. It has been suggested that a decreased ratio of free total costs for chronic haemodialysis treatment. There carnitine to acylcarnitine resp. free carnitine to total is, therefore, a strong incentive to reduce the rhEpo carnitine indicates carnitine deficiency. requirement in dialysis patients by ancillary measures. Plasma concentrations of -carnitine and its subfracStrategies with proven efficacy to reduce rhEpo requiretions may not be an adequate reflection of carnitine ment include: iron supplementation, subcutaneous deficiency or carnitine availability in tissues and cells, mode of administration (compared with i.v. adminisi.e. the site where -carnitine acts. Free carnitine contration), correction of hyperparathyroidism, treatment centrations in muscle have been reported to be subnorof infections and correction of aluminium intoxication. mal in haemodialysis patients [10]. Savica et al. [11] Several less well-proven procedures have recently reported a correlation between plasma free carnitine been summarized by Hörl [1] among them the and muscle free carnitine. administration of -carnitine. Against the above backIn contrast to muscle, erythrocyte intracellular free ground it appears appropriate to discuss the evidence carnitine concentrations are increased whereas the conwhich argues for this suggestion [1]. centrations of acylcarnitine are comparable to normal