Several factors related to preload, afterload, uremic toxins, interleukin 1 alpha (IL-1α), interleukin 6 (IL-6), carnitine deficiency, parathyroid hormone imbalance, high FGF-23, reduced serum Klotho, high circulating phosphate, volume overload, anemia, increased hepcidin, erythropoietin resistance, and endothelial dysfunction bring about these unfavorable nonatherosclerotic changes to the cardiac myocardium. Here, IL6 is linked to systemic primary carnitine deficiency disease.