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In a study in diet-treated diabetic patients, even a single mixed meal of 450 Calories caused immediate and significant impairment in endothelial function, a key early step in the development of atherosclerosis

The role of dietary carnitine in normal metabolism and in cardiovascular disease

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However, 35 years after the first reports on l-carnitine deficiency in haemodialysis patients, routine l-carnitine supplementation is not recommended by KDIGO or KDOQI clinical guidelines covering several aspects of the renal failure patient, based on lack of definitive evidence of benefit [8, 9, 1214]