Editorial L-Carnitine for Anemia in Hemodialysis Patients: A Last Resort

the biologically active form of carnitine, L-carnitine (LC), offers an adjuvant erythropoietic effect to patients with newly diagnosedESRDundergoingmaintenance hemo-dialysis (1). Their hypothesis, addressed in the CARNI-DIAL trial (NCT 00322322) stems fromabundant clinical and bioscientific data that have suggested a multiplicity of salutary effects of LC in the anemia of CKD. LC is adialyzable, 162-Dquaternaryamine that is not bound to albumin in plasma and is stored primarily in muscle. It is also knownas vitaminBT (T for theTenebrio species) after its discovery as a mealworm growth fac-tor in 1952 (2). It is the product of the multistep metab-olism of 6-N-trimethyllysine. Carnitine production may also be driven by the ingestion of certain food-stuffs after its methylated precursor is liberated fro