Effect of an l-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: A 4-Month, prospective, multicenter randomized trial

Mario Bonomini, Lorenzo Di Liberato, Goffredo Del Rosso, Antonio Stingone, Giancarlo Marinangeli, Agostino Consoli, Silvio Bertoli, Amedeo De Vecchi, Emanuele Bosi, Roberto Russo, Roberto Corciulo, Loreto Gesualdo, Francesco Giorgino, Paolo Cerasoli, Augusto Di Castelnuovo, Maria Pia Monaco, Ty Shockley, Claudia Rossi, Arduino Arduini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In peritoneal dialysis, the high glucose load absorbed from dialysis fluid contributes to several metabolic abnormalities, including insulin resistance. We evaluate the efficacy of a peritoneal dialysis solution containing l-carnitine as an additive to improve insulin sensitivity. Study Design: Multicenter parallel randomized controlled trial. Setting & Participants: Nondiabetic uremic patients on continuous ambulatory peritoneal dialysis enrolled in 8 peritoneal dialysis centers. Intervention: Patients were randomly assigned to receive peritoneal dialysis diurnal exchanges with either a standard glucose-based solution (1.5% or 2.5% according to the patient's need) or a glucose-based solution (identical glucose amount) enriched with l-carnitine (0.1%, weight/volume; 2 g/bag) for 4 months, the nocturnal exchange with icodextrin being unmodified. Outcomes & Measurements: The primary outcome was insulin sensitivity, measured by the magnitude of change from baseline in glucose infusion rate (in milligrams per kilogram of body weight per minute) during a euglycemic hyperinsulinemic clamp. Secondary outcomes were safety and tolerability, body fluid management, peritoneal dialysis efficiency parameters, and biochemistry tests. Results: 35 patients were randomly assigned, whereas 27 patients (standard solution, n=12; experimental solution, n = 15) were analyzed. Adverse events were not attributable to treatment. Glucose infusion rates in the l-carnitine-treated group increased from 3.8 ± 2.0 (SD) mg/kg/min at baseline to 5.0 ± 2.2 mg/kg/min at day 120 (P = 0.03) compared with 4.8 ± 2.4 mg/kg/min at baseline and 4.7 ± 2.4 mg/kg/min at day 120 observed in the control group (P = 0.8). The difference in glucose infusion rates between groups was 1.3 (95% CI, 0.0-2.6) mg/kg/min. In patients treated with l-carnitine-containing solution, urine volume did not change significantly (P = 0.1) compared to a significant diuresis reduction found in the other group (P = 0.02). For peritoneal function, no differences were observed during the observation period. Limitations: Small sample size. Conclusions: The use of l-carnitine in dialysis solutions may represent a new approach to improving insulin sensitivity in nondiabetic peritoneal dialysis patients.

Original languageEnglish
Pages (from-to)929-938
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number5
DOIs
Publication statusPublished - Nov 2013

Keywords

  • Carnitine
  • end-stage renal disease
  • insulin sensitivity
  • peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology

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