Despite its use in the treatment of renal anemia, no adequately controlled studies have examined the impact of L-carnitine administration in the patient population for which it is indicated (i.e., those hyporesponsive to erythropoiesis-stimulating agents [ESAs]). This randomized, double-blind, placebo-controlled pilot study evaluated the potential benefit of L-carnitine supplementation for the treatment of renal anemia in chronic hemodialysis patients who were hyporesponsive to ESA treatment.