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Serum carnitine is decreased in hemodialysis patients, which induces muscle atrophy. Thus, we examined the different effects of  l ‐carnitine and exercise on exercise activity and muscle status in hemodialysis patients. Twenty patients were divided into  l ‐carnitine and cycle ergometer groups and were followed for 3 months. Muscle and fat mass, physical activities, and muscle status were evaluated by an impedance, physical function test, and magnetic resonance imaging, respectively. The  l ‐carnitine significantly increased muscle mass ( P  = .023) and thigh circumference ( P  = .027), decreased fat mass ( P  = .007), and shortened chair stand‐up time ( P  = .002) and 10‐m walk test ( P  = .037). The fat fraction was improved by the  l ‐carnitine ( P  = .047). Compared with the exercise group,  l ‐carnitine improved the changes in 10‐m walk test ( P  = .026), chair stand‐up time ( P  = .014), and thigh circumference ( P  = .022). Baseline fibroblast growth factor‐21 and myostatin levels predicted the  l ‐carnitine‐associated changes in exercise activities.  l ‐carnitine, rather than exercise, improved physical activity and muscle status in hemodialysis patients.

l ‐carnitine supplementation vs cycle ergometer exercise for physical activity and muscle status in hemodialysis patients: A randomized clinical trial