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Administration of exogenous carnitine is thought to decrease ammonia levels by binding to VPA, thereby enhancing the -oxidation process and production of acetyl-CoA, and relieving the inhibition of urea synthesis

This can reduce side effects while keeping the treatment effective

Its effectiveness has been demonstrated by numerous clinical studies

Criteria for obtaining a valid VO 2peak included: the point at which VO 2 did not increase by more than 1.5 ml kg 1 min 1 with an increase in work rate, an RER value greater than 1.20, or when the participant reached volitional exhaustion

Causes include impaired absorption in the gastrointestinal tract, losses during HD, and inadequate dietary intake

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