Safety and efficacy of L carnitine supplementation in improving cardiac function of hemodialysis patients: a systematic review and meta analysis International Urology and Nephrology Springer Nature Link Hong Kong Journal of Paediatrics [HK J Paediatr (New Series) 2020;25:23 29] L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Acetyl L Carnitine for Heart, Diabetes & Kidney Health Kidney Coach
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