Abstract: Objective To study the impact of levocarnitine on malnutrition and heart failure in elderly hemodialysis (MHD) patients with malnutrition and heart failure. Methods 127 elderly patients on MHD were randomly divided into treatment group and control group. The treatment group was given levocarnitine 1g by intravenous injection at the end of each hemodialysis. The duration of therapy was 2 months. The control group was given physiological saline by intravenous injection at the end of each hemodialysis. The frequency and duration of therapy were the same in the two groups. Serum albumin, prealbumin, transferrin, hemoglobin, dry weight and echocardiography were measured. Results Serum albumin, prealbumin, transferrin, hemoglobin dry weight were increased in treatment group (P<0.01). As the nutritional status improved, the LVEF in treatment group increased and the Tei index decreased when compared with control group (P<0.01). Conclusions Levocarnitine can significantly improve malnutrition and left ventricular function in elderly hemodialysis patients.