How often do you check carnitine levels in your patients with end stage kidney disease on hemodialysis?

About 10 years ago I used to check carnitine levels in ESRD patients with intradialytic hypotension commonly. If low then I would treat with levocarnitine. At some point I gave up on the practice not because it was not working but because it was hard to determine if it was working or not. I am aware that carnitine supplementation has also been used for other associated problems such as ESA resistant anemia. Thanks for this reminder, I will try to check carnitine levels more often again.

I have also checked carnitine only a couple of times over the last few years - once for intradialytic hypotension in a setting of cardiomyopathy on a young patient and another one for ESA-resistant anemia. Cartinine was low in both patients and the supplementation did improve intra-dialytic hypotension but did not remarkably change ESA-resistant anemia. I think there are subsets of patients where this might be helpful.