***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Since carnitine deficiency has been reported in some patients undergoing maintenance hemodialysis , we studied the effects of intravenous infusion of L-carnitine or placebo at the end of each dialysis treatment . The trial , which lasted seven months ( one month baseline , 6 months treatment ) was multicenter , double blind , placebo controlled , and r and omized . Eighty-two long-term hemodialysis patients , who were given either carnitine ( N = 38 ) or placebo ( N = 44 ) , completed this study . In each group , clinical and biochemical parameters during treatment were compared with baseline values . Intra-dialytic hypotension and muscle cramps were reduced only in the carnitine treated group , while improvement in post-dialysis asthenia was noticed in both carnitine and placebo groups . Maximal oxygen consumption , measured during a progressive work exercise test , improved significantly in the carnitine group ( 111 + /- 50 ml/min . P less than 0.03 ) and was unchanged in the placebo group . L-carnitine treatment was associated with a significant drop in pre-dialysis concentrations of serum urea nitrogen , creatinine and phosphorus ( means + /- SEM , 101 + /- 4.5 to 84 + /- 3.9 , 16.7 + /- 0.67 to 14.7 + /- 0.64 , and 6.4 + /- 0.3 to 5.5 + /- 0.4 mg/dl , respectively , P less than 0.004 ) . No significant changes in any of these variables were noticed in the placebo group . Mid-arm circumference and triceps skinfold thickness were measured in 11 carnitine and 13 placebo treated patients . Calculated mid-arm muscle area increased in the carnitine patients ( 41.37 + /- 2.68 to 45.6 + /- 2.82 cm2 , P = 0.05 ) and remained unchanged in the placebo patients . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Carnitine insufficiency is responsible for various co-morbid conditions in maintenance hemodialysis ( MHD ) patients .  L-carnitine supplementation is expected to improve the quality of life ( QoL ) of patients on MHD . AIMS To study the effect of L-carnitine supplementation on QoL of Indian patients on MHD . SETTING AND DESIGN This was a single ( patient ) blind , r and omized , placebo-controlled clinical trial conducted on patients on MHD attending hemodialysis unit of the study center . MATERIAL S AND METHODS Twenty patients on MHD suffering from hemodialysis-related symptoms were r and omly assigned to receive intravenous L-carnitine 20 mg/kg or placebo after every dialysis session for 8 weeks . SF36 ( Short Form with 36 questions ) score for QoL , laboratory investigations and dialysis related symptoms were recorded at baseline and after 8 weeks . Improvement in QoL , laboratory parameters and dialysis related symptoms in the two groups after 8 weeks was compared . STATISTICAL ANALYSIS USED Depending on normality of data , unpaired T test or Mann Whitney U test was used for comparison of change ( 8 weeks-baseline ) in SF36 scores and laboratory parameters observed in the two groups . RESULTS L-carnitine supplementation increased total SF36 score by 18.29 + /- 12.71 ( 95 % CI : 10.41 to 26 ) while placebo result ed in reduction in total SF36 score by 6.4 + /- 16.39 ( 95 % CI : -16.59 to 3.73 ) . L-carnitine also result ed in significant increase in hemoglobin and serum albumin and decrease in serum creatinine as compared to placebo . More patients were relieved of dialysis related symptoms in L-carnitine group . CONCLUSION Intravenous L-carnitine supplementation improves QoL in patients on MHD INTRODUCTION Dyslipidemia and high serum lipoprotein(a ) are among the risk factors for cardiovascular diseases in hemodialysis patients .  Statins as a first line of therapy in hyperlipidemia does not always reduce the serum lipoprotein(a ) level . Several studies have reported the lipid-lowering effects of carnitine and coenzyme Q10 in hemodialysis patients . This study was design ed to investigate the effects of carnitine and coenzyme Q10 on serum lipid profile and lipoprotein(a ) level in maintenance hemodialysis patients . MATERIAL S AND METHODS This was a r and omized placebo-controlled trial . We studied on hemodialysis patients who were on treatment with atorvastatin or lovastatin to assess the efficacy of supplement therapy . They were divided into 4 groups to receive carnitine , coenzyme Q10 , both carnitine and coenzyme Q10 , and placebo . After a 3-month experiment , blood sample s were collected to measure serum levels of lipoprotein(a ) , triglyceride , total cholesterol , high-density lipoprotein cholesterol and low-density lipoprotein cholesterol . RESULTS Fifty-two hemodialysis patients , 27 men and 25 women , completed the course of the study . Three months after supplement therapy , serum levels of lipoprotein(a ) reduced significantly in the carnitine , coenzyme Q10 , and combination groups compared to the baseline values and the 3-month value of lipoprotein(a ) in the placebo group ( P = .01 ) . Serum levels of triglyceride and other lipoproteins did not significantly alter . CONCLUSIONS Our study showed that supplementation with carnitine and coenzyme Q10 could reduce serum levels of lipoprotein(a ) in maintenance hemodialysis patients treated with statins In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia , anemia , and general health in these patients . We evaluated the effect of oral L-carnitine supplementation on lipid profiles , anemia , and quality of life ( QOL ) in hemodialysis patients . In a r and omized , double-blinded , placebo-controlled trial , end-stage renal disease ( ESRD ) patients on hemodialysis received either L-carnitine 1 g/d ( n = 24 ) or placebo ( 27 patients ) for 16 weeks . At the end of the study , there was a significant decrease in triglyceride ( −31.1 ± 38.7 mg/dL , P = 0.001 ) and a significant increase in HDL ( 3.7 ± 2.8 mg/dL , P < 0.001 ) levels in the carnitine group . Decrease in total cholesterol ( −6.6 ± 16.0 mg/dL , P = 0.075 ) and increase in hemoglobin ( 0.7 ± 1.7 g/dL , P = 0.081 ) concentrations in the carnitine group were not significant . There was no statistically significant changes in LDL in any group ( P > 0.05 ) . Erythropoietin dose was significantly decreased in both the carnitine ( −4750 ± 5772 mg , P = 0.001 ) and the placebo group ( −2000 ± 4296 mg , P < 0.05 ) . No improvement was observed in QOL scores of two groups . In ESRD patients under maintenance hemodialysis  , oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL Previous studies have reported conflicting results of carnitine supplementation on plasma lipids in patients with chronic renal failure . We therefore performed a four center , double-blind placebo controlled trial to evaluate the effects of post-hemodialysis intravenous injection of L-carnitine in ESRD patients on maintenance hemodialysis . Thirty-eight patients received up to six months of L-carnitine infusions ( 20 mg/kg ) post-dialysis and 44 patients received placebo infusions .  In both groups of patients , baseline pre-dialysis plasma and red blood cell total carnitine levels were normal , but pre-dialysis plasma-free carnitine concentrations and free/total ratios were subnormal , and plasma acyl levels were elevated . Post-dialysis plasma free and total carnitine concentrations were also subnormal . Plasma and red blood cell total carnitine levels rose eightfold in carnitine recipients , but were unchanged from baseline in those receiving placebo . There were no significant changes observed in plasma triglycerides , HDL-cholesterol or other lipoprotein parameters in either the carnitine or placebo treated groups . We conclude that carnitine metabolism is altered in uremia . Furthermore , in a r and omly-selected hemodialysis population , L-carnitine injection at the dose of 20 mg/kg results in significant increases in blood ( and perhaps tissue ) carnitine levels , but this is not associated with any major effects on lipid profiles L-Carnitine supplementation has shown beneficial effects in patients on hemodialysis . We studied 36 ESRD adult patients with a mean age of 47.5 + /- 15 years to evaluate the effect of L-Carnitine supplementation on hemoglobin , lipid levels and physical performance in patients on hemodialysis . The study group consisted of 18 r and omly selected patients who received L-Carnitine 15 mg/kg  and the  control group consisted of 18 r and omly selected patients who received equal volume of normal saline as a placebo three times a week for six months . Laboratory tests were performed at baseline , then monthly until the end of the study . A significant increase in the hemoglobin ( Hb ) and hematocrit ( HCT ) in the presence of unchanged doses of erythropoietin hormonal supplementation was observed ( pre 79 + /- 7.5 gm/l , post 103 + /- 10.6 gm/l ) P < 0.001 ( pre 24+/- 2 % , post 33 + /- 4 % ) P < 0.001 respectively ) in the L-Carnitine treated group . Similarly total serum cholesterol ( TCL ) and serum triglyceride ( TG ) levels showed a statistically significant decrease in the study group , TCL ( pre 4.6 + /- 1.2 , post 3.7 + /- 1.1 mmol/L ) , P < 0.03 and TG ( pre 3.1 + /- 1.7 , post 1.8 + /- 0.6 mmol/L ) P < 0.004 . The physical performance as assessed by mild and moderate exercise showed a trend towards improvement . There was a significant increase in free carnitine and total carnitine levels in the L-Carnitine treated group . In conclusion , these results demostrate positive effect of L-Carnitine supplementation in the hemodialysis patients marked by an increase in Hb , HCT , a decrease in TCL and TG and improved physical performance in comparison to the control group OBJECTIVE We studied the effects of l-carnitine supplement on serum amyloid A ( SAA ) , a systemic inflammation marker , and vascular inflammation markers in hemodialysis patients . DESIGN This was a r and omized , double-blind , placebo-controlled trial . SETTING The study was performed in Soodeh Hemodialysis Center in Islamshahr , Iran . PATIENTS We included 36 hemodialysis patients ( 15 men and 21 women ) . INTERVENTION The patients on hemodialysis were r and omly assigned to either a carnitine or a placebo group . Patients in the carnitine group received 1,000 mg/day oral l-carnitine for 12 weeks , whereas patients in the placebo group received a corresponding placebo during the study . MAIN OUTCOME MEASURES Serum free carnitine , SAA , soluble intercellular adhesion molecule type 1 , soluble intercellular adhesion molecule type 2 , soluble vascular cell adhesion molecule type 1 , sE-selectin , sP-selectin , and oxidized low-density lipoprotein were measured at baseline and at the end of week 12 of the study . RESULTS Mean serum free carnitine concentration increased significantly to 150 % of baseline in the carnitine group at the end of week 12 ( P < .001 ) , whereas serum SAA showed a significant 32 % decrease ( P < .001 ) . No significant changes were observed in the serum concentrations of free carnitine and SAA in the placebo group during the study . There were no significant differences between the two groups in mean changes in serum soluble intercellular adhesion molecule type 1 , soluble intercellular adhesion molecule type 2 , soluble vascular cell adhesion molecule type 1 , sE-selectin , sP-selectin , and oxidized low-density lipoprotein concentrations . CONCLUSION The study indicates that l-carnitine supplement reduces serum SAA , which is a risk factor for cardiovascular diseases in hemodialysis patients , but has no effect on vascular inflammation markers BACKGROUND Patients on long-term hemodialysis become deficient in carnitine and are frequently treated with carnitine supplementation to offset their renal anemia , lipid abnormality and cardiac dysfunction . The therapeut 
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Conclusions There is no evidence that l-carnitine can improve the inflammation , oxidative stress , nutrition , anemia , dyslipidemia , hyperparathyroidism status or quality of life in HD patients .
However , given method ological limitations and lack of hard endpoints , high- quality , long-term r and omized trials are required to fully eluci date the clinical value of l-carnitine administration in hemodialysis patients