title: Effects of levocarnitine on brachial-ankle pulse wave velocity in hemodialysis patients: a randomized controlled trial.
abstract: OBJECTIVE
  Atherosclerotic cardiovascular disease is the most common cause of mortality in patients with end-stage kidney disease. Chronic kidney disease patients often exhibit a deficiency in L-carnitine due to loss during hemodialysis (HD). We studied the effects of L-carnitine supplementation on brachial-ankle pulse wave velocity (baPWV), a marker of atherosclerosis, in HD patients.
  
  
  METHODS
  This was a prospective, open-label, randomized, parallel controlled, multi-center trial testing the anti-atherosclerotic efficacy of oral L-carnitine administration (20 mg/kg/day). HD patients (n = 176, mean age, 67.2 ± 10.3 years old; mean duration of HD, 54 ± 51 months) with plasma free L-carnitine deficiency (<40 μmol/L) were randomly assigned to the oral L-carnitine group (n = 88) or control group (n = 88) and monitored during 12 months of treatment.
  
  
  RESULTS
  There were no significant differences in baseline clinical variables between the L-carnitine and control groups. L-carnitine supplementation for 12 months significantly increased total, free, and acyl carnitine levels, and reduced the acyl/free carnitine ratio. The baPWV value decreased from 2085 ± 478 cm/s at baseline to 1972 ± 440 cm/s after six months (p < 0.05) to 1933 ± 363 cm/s after 12 months (p < 0.001) of L-carnitine administration, while no significant changes in baPWV were observed in the control group. Baseline baPWV was the only factor significantly correlated with the decrease in baPWV.
  
  
  CONCLUSIONS
  L-carnitine supplementation significantly reduced baPWV in HD patients. L-carnitine may be a novel therapeutic strategy for preventing the progression of atherosclerotic cardiovascular disease.
authors.affiliation: Department of Nephrology, Keiai Hospital, Tokyo 173-0036, Japan. thiguchi@keiai-hospital.jp.
authors.forename: Terumi
authors.initials: T
authors.lastname: Higuchi
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. abe.masanori@nihon-u.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Nephrology, Keiai Hospital, Tokyo 173-0036, Japan. zakio@keiai-hospital.jp.
authors.forename: Toshio
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Department of Nephrology, Keiai Hospital, Tokyo 173-0036, Japan. mari@keiai-hospital.jp.
authors.forename: Mari
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Nephrology, Keiai Hospital, Tokyo 173-0036, Japan. erina@keiai-hospital.jp.
authors.forename: Erina
authors.initials: E
authors.lastname: Okawa
authors.affiliation: Department of Cardiology, Keiai Hospital, Tokyo 173-0036, Japan. ando@keiai-hospital.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ando
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. oikawa.osamu@nihon-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Oikawa
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. kokada@med.nihon-u.ac.jp.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Nephrology, Meirikai Chuo General Hospital, Tokyo 114-0001, Japan. fkikuchi@ims.or.jp.
authors.forename: Fumito
authors.initials: F
authors.lastname: Kikuchi
authors.affiliation: Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. souma.masayoshi@nihon-u.ac.jp.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Soma
mesh_terms: D000284:Administration, Oral; D000368:Aged; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000401:mortality / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity / Q000187:drug effects*; D002331:Carnitine / Q000031:analogs & derivatives / Q000097:blood / Q000172:deficiency / Q000494:pharmacology*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011673:Pulsatile Flow; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D015415:Biomarkers; C116917:acylcarnitine; D002331:Carnitine