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Effect of an L-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: a 4-month, prospective, multicenter randomized trial.
Am J Kidney Dis. 2013 Nov; 62(5):929-38.AJ

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.

Authors+Show Affiliations

Department of Medicine, Institute of Nephrology, G. d'Annunzio University, Chieti-Pescara, Italy. Electronic address: m.bonomini@nephro.unich.it.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23725973

Citation

Bonomini, Mario, et al. "Effect of an L-carnitine-containing Peritoneal Dialysate On Insulin Sensitivity in Patients Treated With CAPD: a 4-month, Prospective, Multicenter Randomized Trial." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 62, no. 5, 2013, pp. 929-38.
Bonomini M, Di Liberato L, Del Rosso G, et al. Effect of an L-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: a 4-month, prospective, multicenter randomized trial. Am J Kidney Dis. 2013;62(5):929-38.
Bonomini, M., Di Liberato, L., Del Rosso, G., Stingone, A., Marinangeli, G., Consoli, A., Bertoli, S., De Vecchi, A., Bosi, E., Russo, R., Corciulo, R., Gesualdo, L., Giorgino, F., Cerasoli, P., Di Castelnuovo, A., Monaco, M. P., Shockley, T., Rossi, C., & Arduini, A. (2013). Effect of an L-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: a 4-month, prospective, multicenter randomized trial. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 62(5), 929-38. https://doi.org/10.1053/j.ajkd.2013.04.007
Bonomini M, et al. Effect of an L-carnitine-containing Peritoneal Dialysate On Insulin Sensitivity in Patients Treated With CAPD: a 4-month, Prospective, Multicenter Randomized Trial. Am J Kidney Dis. 2013;62(5):929-38. PubMed PMID: 23725973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of an L-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: a 4-month, prospective, multicenter randomized trial. AU - Bonomini,Mario, AU - Di Liberato,Lorenzo, AU - Del Rosso,Goffredo, AU - Stingone,Antonio, AU - Marinangeli,Giancarlo, AU - Consoli,Agostino, AU - Bertoli,Silvio, AU - De Vecchi,Amedeo, AU - Bosi,Emanuele, AU - Russo,Roberto, AU - Corciulo,Roberto, AU - Gesualdo,Loreto, AU - Giorgino,Francesco, AU - Cerasoli,Paolo, AU - Di Castelnuovo,Augusto, AU - Monaco,Maria Pia, AU - Shockley,Ty, AU - Rossi,Claudia, AU - Arduini,Arduino, Y1 - 2013/05/29/ PY - 2012/12/14/received PY - 2013/04/06/accepted PY - 2013/6/4/entrez PY - 2013/6/4/pubmed PY - 2014/2/15/medline KW - Carnitine KW - end-stage renal disease KW - insulin sensitivity KW - peritoneal dialysis SP - 929 EP - 38 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 62 IS - 5 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/23725973/Effect_of_an_L_carnitine_containing_peritoneal_dialysate_on_insulin_sensitivity_in_patients_treated_with_CAPD:_a_4_month_prospective_multicenter_randomized_trial_ DB - PRIME DP - Unbound Medicine ER -