Background/Aims: Hospitalizations account for 41% of the total cost of end-stage renal disease (ESRD) care. Carnitine deficiency is common among dialysis patients, and some studies have shown improvements in anemia, and cardiac and skeletal muscle function upon administration of L-carnitine. We hypothesized that L-carnitine may be associated with decreased hospital utilization in these patients. Methods: The Fresenius Medical Care North America dialysis database was used for this retrospective analysis. Adult patients who received carnitine for at least 3 months, and had at least 3 months of pre-carnitine follow-up were included in the study. Hospitalization and hospital day rates were compared before and during carnitine therapy, and with a matched population. Results: Carnitine therapy at a mean dose of 1.5 ± 0.7 g per administration for an average of 9.7 ± 5.4 months was associated with a significant reduction in hospital utilization. Patients with cardiovascular disease, defined as hospitalizations for angina, myocardial infarction, arrhythmia, congestive heart failure, cerebral vascular disease or peripheral vascular disease prior to receiving carnitine, and those with anemia and hypoalbuminemia derived the greatest benefit from carnitine therapy. In a multivariate analysis, compared to 3 months prior to the initiation of carnitine, the adjusted relative risk for hospitalization was 11, 11, and 15% lower at 3, 6, and 9 months, respectively. Among patients with cardiovascular disease, the reduction in risk was even more significant (24, 31, and 34% lower at 3, 6, and 9 months, respectively). Similar results were observed with adjusted relative risk for hospital days. Conclusion: Administration of L-carnitine to chronic hemodialysis patients is associated with lower hospital utilization.