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Uraemic cardiomyopathy is characterized by extensive metabolic remodelling, including secondary carnitine deficiency, reduced fatty acid use, enhanced glucose utilization, mitochondrial dysfunction and altered expression of metabolic regulatory genes, which collectively result in impaired energetics

Additionally, damaged mitochondria release mtDNA into the cytosol, activating the innate immune system via damage-associated molecular patterns (DAMPs) (251, 377), modulating both innate and adaptive immune responses (377379)

B Vitamins for Energy B3, B5, B6, B12 help reduce tiredness and support energy metabolism

Finally, due to the use of cross-sectional and casecontrol designs, we could not assess temporal associations of carnitine levels with BMD and recent osteoporotic fracture, which limited causal inference

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