Introduction and Aims: Hyperglycemia and aggravated oxidative stress are well known to promote the production of advanced glycation end products (AGEs), which can lead to cardiovascular disease in patients with maintenance hemodialysis (HD). Carnitine, substantially reduced in HD patients, is reported to improve insulin resistance and reduce oxidative stress. We hypothesized that carnitine administration prevented the progress of arteriosclerosis effectively by reducing AGEs in HD patients. The aim of this study was to investigate the effects of carnitine administration on AGEs and arteriosclerosis in them.
Methods: We recruited 32 patients (11 men and 21 women, 64 ± 13 years) undergoing HD three times a week who were diagnosed as carnitine deficiency because of serum free carnitine level <36µmol/L, Patients with coronary heart disease, malignancy, or significant malnutrition, or those with regularly taking a carnitine supplement were excluded. Patients were divided into two groups according to the presence or absence of L-carnitine administration: carnitine group and control group. L-carnitine was given 1,000 mg i.v. after HD session three times a week for 10 months. Serum free carnitine level was measured before HD session. We measured plasma pentosidine and skin autofluorescence (SAF) as parameters of AGEs and assessed cardio-ankle vascular index (CAVI) as a parameter of arteriosclerosis. A two-way analysis of variance for repeated measures with post hoc Bonferroni test was used to analyze the differences in the other parameters between the groups and among the two stages (before and after the treatment period). Plasma pentosidine, SAF and CAVI were used. The change of CAVI before and after the treatment period (⊿CAVI) was compared between two groups using an unpaired t-tset.
Results: Serum free carnitine ranged from 16.2 to 34.3 μmol/L before the treatment period, and was significantly higher after the treatment period than before in the carnitine group (P<0.01). Although no significant change was found in plasma pentosidine before and after the treatment period in two groups, SAF and CAVI measured after the treatment period were significantly lower than before the treatment period in the carnitine group (P<0.05, respectively). ⊿CAVI was significantly lower in the carnitine group than in the control group (P<0.05).
Conclusions: Carnitine administration prevents the progress of arteriosclerosis by reducing AGEs in non-diabetic maintenance HD patients
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