Objective To investigate the therapeutic effect of L?carnitine combined with erythropoietin (EPO) and iron on renal anemia in rats. Methods The renal anemia rat model was established using adenine. All rats were randomly divided into three groups: control group (group A), EPO combined with iron group (group B), and L?carnitine combined with EPO and iron treatment group (group C). The levels of red blood cells (RBC), hemoglobin (Hgb), hematocrit (Hct), C?reactive protein (CRP), Fe in peripheral blood (Fe), serum ferritin (SF) and transferrin saturation (TS) were measured. Pathological changes in the kidney, liver and small intestine tissues were examined using HE staining. Results Compared with the group A, the levels of RBC, Hgb, Hct, Fe, SF, and TS were significantly increased, however, the level of CRP significantly decreased in the groups B and C (P < 0.05). In the group C, the levels of RBC, Hgb, and CRP was higher than the group B (P < 0.05). Furthermore, the pathological changes in the kidney, liver and small intestine tissues were improved in the groups B and C. Conclusions L?carnitine combined with EPO and iron has a therapeutic effect on renal anemia in rats, thus, it deserves further studies and application.