Journal Article

Insulin action on glucose and protein metabolism during <span class="smallCaps">l</span>-carnitine supplementation in maintenance haemodialysis patients

Gianni Biolo, Manuela Stulle, Francesco Bianco, Giuseppe Mengozzi, Rocco Barazzoni, Alfonso Vasile, Giovanni Panzetta and Gianfranco Guarnieri

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 3, pages 991-997
Published in print March 2008 | ISSN: 0931-0509
Published online November 2007 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm664
Insulin action on glucose and protein metabolism during l-carnitine supplementation in maintenance haemodialysis patients

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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

Journal Article.  5174 words.  Illustrated.

Subjects: Nephrology

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