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Carnitine depletion in haemodialysis patients is caused by insufficient carnitine synthesis and excessive loss through the dialytic membranes (Matera et al 2003). Carnitine supplementation has been approved by the US FDA for the treatment and prevention of carnitine depletion in dialysis patients. Supplementation in such patients is said to improve lipid metabolism, protein nutrition, antioxidant status, and anaemia and may reduce the incidence of intradialytic muscle cramps, hypotension, Carnitine 188

asthenia, muscle weakness, and cardiomyopathy (Bellinghieri etal 2003). However,

the routine use of l-carnitine in dialysis patients to manage anaemia and refractory dialysis-associated hypotension is contentious and some authors believe that there is insufficient evidence to support this indication (Steinman et al 2003).

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