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A lack of carnitine in dialysis patients is caused by insufficient carnitine synthesis and by the loss through dialytic membranes, leading, in some patients, to carnitine depletion and a concomitant relative increase in esterified forms of carnitine [43]

Kaohsiung J Med Sci 36(9):699704

In excess, homocysteine can cause hyperhomocysteinemia, which is a well-established risk factor for CVD