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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]

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Biochemical Differences Between L-Carnitine and Acetyl-L-Carnitine Although they stem from the same base, their biochemical roles differ: Molecular Structure: ALCAR has an added acetyl group, enhancing its ability to cross into the brain