In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia, anemia, and general health in these patients. We evaluated the effect of oral L-carnitine supplementation on lipid profiles, anemia, and quality of life (QOL) in hemodialysis patients. In a randomized, double-blinded, placebo-controlled trial, end-stage renal disease (ESRD) patients on hemodialysis received either L-carnitine 1 g/d (n=24) or placebo (27 patients) for 16 weeks. At the end of the study, there was a significant decrease in triglyceride (-31.1±38.7 mg/dL,P=0.001) and a significant increase in HDL (3.7±2.8 mg/dL,P<0.001) levels in the carnitine group. Decrease in total cholesterol (−6.6±16.0 mg/dL,P=0.075) and increase in hemoglobin (0.7±1.7 g/dL,P=0.081) concentrations in the carnitine group were not significant. There was no statistically significant changes in LDL in any group (P>0.05). Erythropoietin dose was significantly decreased in both the carnitine (-4750±5772 mg,P=0.001) and the placebo group (-2000±4296 mg,P<0.05). No improvement was observed in QOL scores of two groups. In ESRD patients under maintenance hemodialysis, oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL.