Objective To study the effects of levocarnitine on recombinant human erythropoietin (rhEPO)dose and microinflammatory state in maintenance hemodialysis patients. Methods Totally 326 maintenance hemodialysis patients were randomly divided into 2 groups: the treatment group (n=163) and the control group (n=163). The age, gender, course of disease, and conventional treatments were similar in the 2 groups. To maintain the hemoglobin (HB) within 110-120 g/L and hematocrit (HCT) at 33%-35%, the treatment group was given levocarnitine and rhEPO, and the control group was given rhEPO only. The weekly dose of rhEPO (IU/kg) and the erythropoietin response index (ERI) were calculated and compared between the two groups 8 months later. Meanwhile, the serum high-sensitivity C-reactive protein (hs-CRP) was monitored in the 2 groups before and after 8 months. Results The weekly dose of rhEPO required for the treatment group was significantly lower than that required for the control group (\[106±20\] IU/kg vs \[141±23\] IU/kg, P<0.05); the treatment group also had significantly lower ERI compared with the control group (\[0.93±0.11\] IU·L·kg^-1·g^-1 vs \[1.35±0.29\] IU·L·kg^-1·g^-1, P<0.05). Serum hs-CRP level in the treatment group was significantly decreased 8 months after treatment (\[5.21±3.20\] mg/L vs \[10.33±2.54\] mg/L,P<0.05), and it was also significantly lower than that in the control group after the treatment (\[5.21±3.20\] mg/L vs \[9.93±2.12\] mg/L, P<0.05). Serum hs-CRP levels were not changed significantly in the control group before and after the treatment. Conclusion Levocarnitine can reduce the dose of rhEPO in MHD patients, which might be associated with improvements of the microinflammation and erythropoietin resistance in MHD patients.