Objective To explore the clinical curative effect of levocarnitine combined with compound α-ketonic acid on patients with end-stage renal disease (ESRD) after maintenance hemodialysis (MHD). Methods A total of 104 patients with ESRD undergoing MHD in the hospital were enrolled as the research objects from December 2020 to December 2022, and they were randomly divided into control group (52 cases, α-ketonic acid) and treatment group (52 cases, levocarnitine). The nutritional indexes ［albumin (ALB), prealbumin (PA), hemoglobin (HGB)］, inflammatory factors ［interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP)］, oxidative stress indexes ［malondialdehyde (MDA), superoxide dismutase (SOD)］ and cardiac function indexes ［end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular］ before and after treatment, and safety during treatment in the two groups were compared. Results After treatment, levels of ALB, PA and HGB were increased in both groups, which were higher in treatment group than control group (P<0.05). After treatment, levels of IL-6 and hs-CRP in both groups were decreased, which were lower in treatment group than control group (P<0.05). After treatment, MDA was decreased, while SOD was increased in both groups, and the two indexes were better in treatment group than control group (P<0.05). After treatment, LEVDD decreased and LVEF increased in both groups, and compared with control group, the treatment group was better(P<0.05). During treatment, there was no significant difference in safety between the two groups (P>0.05).Conclusion Levocarnitine combined with compound α-ketonic acid can improve malnutrition, inhibit inflammatory factors and oxidative stress response, and improve cardiac function in ESRD patients undergoing MHD, with good safety