title: Effect of an L-carnitine-containing peritoneal dialysate on insulin sensitivity in patients treated with CAPD: a 4-month, prospective, multicenter randomized trial.
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.
  
  
  METHODS
  Multicenter parallel randomized controlled trial.
  
  
  METHODS
  Nondiabetic uremic patients on continuous ambulatory peritoneal dialysis enrolled in 8 peritoneal dialysis centers.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Medicine, Institute of Nephrology, G. d'Annunzio University, Chieti-Pescara, Italy. Electronic address: m.bonomini@nephro.unich.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Bonomini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Liberato
authors.forename: Goffredo
authors.initials: G
authors.lastname: Del Rosso
authors.forename: Antonio
authors.initials: A
authors.lastname: Stingone
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marinangeli
authors.forename: Agostino
authors.initials: A
authors.lastname: Consoli
authors.forename: Silvio
authors.initials: S
authors.lastname: Bertoli
authors.forename: Amedeo
authors.initials: A
authors.lastname: De Vecchi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bosi
authors.forename: Roberto
authors.initials: R
authors.lastname: Russo
authors.forename: Roberto
authors.initials: R
authors.lastname: Corciulo
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Francesco
authors.initials: F
authors.lastname: Giorgino
authors.forename: Paolo
authors.initials: P
authors.lastname: Cerasoli
authors.forename: Augusto
authors.initials: A
authors.lastname: Di Castelnuovo
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Monaco
authors.forename: Ty
authors.initials: T
authors.lastname: Shockley
authors.forename: Claudia
authors.initials: C
authors.lastname: Rossi
authors.forename: Arduino
authors.initials: A
authors.lastname: Arduini
mesh_terms: D000328:Adult; D000368:Aged; D002331:Carnitine / Q000627:therapeutic use*; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D015309:Glucose Clamp Technique; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015314:Dialysis Solutions; D005947:Glucose; D002331:Carnitine
keywords: Carnitine; end-stage renal disease; insulin sensitivity; peritoneal dialysis