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Primary systemic carnitine deficiency can happen when the protein that is responsible for bringing carnitine into cells undergoes a genetic change

doi:10.3233/NRE-130875 Castellanos MJ, Fuente A

As mentioned, chronic kidney disease and dialysis can cause a variety of metabolic disorders, including disturbances of carnitine homeostasis [2,3]

TG, triglycerides

In addition, TMAO induces several inflammatory pathways, which cause the activation of pro-inflammatory cytokines such as IL-6 and TNF- which causes chronic inflammation thereby causing plaque formation and plaque rupture leading to cardiovascular disease [71]