NDT Advance Access originally published online on November 28, 2007
Nephrology Dialysis Transplantation 2008 23(3):991-997; doi:10.1093/ndt/gfm664
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Insulin action on glucose and protein metabolism during L-carnitine supplementation in maintenance haemodialysis patients
1 Department of Clinical Morphological Technological Sciences, Division of Internal Medicine, University of Trieste, Trieste, Italy 2 Renal Unit, Ospedali Riuniti di Trieste, Trieste, Italy 3 Renal Unit, Azienda Ospedaliera di Palmanova, Palmanova, Italy
Gianni Biolo, MD, PhD, DSCMT-Clinica Medica, University of Trieste, Ospedale di Cattinara, Strada di Fiume, 447, Trieste 34149, Italy. Tel: +39-040-399-4532; Fax: +39-040-399-4593; E-mail: biolo{at}units.it
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Abstract |
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Background. Impaired protein anabolism and insulin resistance are characteristic features of maintenance haemodialysis patients. We have used a randomised, matched-paired, double-blind, placebo-controlled experimental design to determine the capability of intravenous L-carnitine supplementation to modify insulin resistance and protein catabolism in non-diabetic patients with end-stage renal disease (ESRD) undergoing chronic haemodialysis treatment.
Methods. L-carnitine (20 mg·kg–1) (n = 9) or placebo (n = 10) were given intravenously at the end of seven consecutive dialysis sessions. Whole-body protein and glucose metabolism were assessed on interdialytic days by the L[1-13C]leucine and the [2,2-2H2]glucose kinetic models in the postabsorptive state and during euglicemic hyperinsulinemic clamp studies at baseline and at the end of the treatment period.
Results. L-carnitine supplementation was associated with lower (P < 0.05) rates of leucine oxidation (–11 ± 12%) and appearance from proteolysis (–6 ± 2%) during the clamp studies than after placebo supplementation. The rates of glucose appearance in the postabsorptive state did not change significantly in the patients receiving L-carnitine treatment. Insulin-mediated glucose disappearance was improved by L-carnitine only in those patients (n = 5) (+18 ± 3%, P < 0.05 vs placebo group, n = 5) with greater baseline insulin resistance, selected according to the median value of insulin sensitivity before treatment.
Conclusions. L-carnitine supplementation was associated with protein-sparing effects in maintenance haemodialysis patients during hyperinsulinemia.
Keywords: carnitine; haemodialysis; insulin resistance; protein kinetics; stable isotopes; uremia
Received for publication: 12. 3.07
Accepted in revised form: 29. 8.07
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