MO762: Effect of the Combined use of Magnesium Aspartate and L-Carnitine on the Progression of Heart Valve Disease and Endothelial Damage in Diabetic Haemodialysis Patients

Abstract

Abstract BACKGROUND AND AIMS The problem of treatment and prevention of heart valve disease (HVD) as a predictor of cardiovascular events in type 2 diabetic patients undergoing haemodialysis (HD) is far from a satisfactory solution. In this context, it is reasonable to develop new therapeutic strategies based on advances of science of the important role of magnesium deficiency, chronic inflammation and endothelial damage in mechanisms of cardiac valve calcification (CVC) formation. Thus, the purpose of the present study was to evaluate the effect of the combined use of magnesium aspartate and L-carnitine on the progression of HVD and endothelial injury in the dynamics of complex 12-month treatment of diabetic HD patients. METHOD A total of 42 type 2 diabetic HD patients were included in this prospective cohort study (male, 26; age, 59.5 ± 0.7 years; HD duration, 31.2 ± 4.6 months; diabetes mellitus duration, 174.6 ± 7.8 months). Depending on the treatment program, patients were divided into two groups: the main group (n = 22) in addition to basic treatment (hypoglycemic, antihypertensive therapy, according to indications—correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by a combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the comparison group (n = 20) was only on the standard therapy. Complex treatment lasted 12 months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate—by three 2-month courses/year. The structure of mitral (MV) and aortic (AV) valves was detected by ultrasound and characterized as normal, thickening and calcification. Plasma content of circulating endothelial cells (CECs) was determined by phase contrast microscopy. Quantitative data are expressed as means ± SEM, qualitative ones—as %. Wilcoxon T-test was used for comparison of the dependent variables and the Mann–Whitney U-test was used for independent ones. RESULTS According to the data presented in Table 1, the incidence of new cases of both calcification of MV and AV in diabetic HD patients who received basic therapy was 10%/year, while the prevalence of CVC in subjects who included a combination of magnesium aspartate and L-carnitine in the standard treatment after 12 months of observation did not change. By the end of the follow-up, the CECs number in patients, who were on complex therapy, was 48.1% (20.6 ± 1.8 versus 9.9 ± 1.4 ×104/L; Z = 3.93, P <0.001) from baseline, a similar index in patients receiving basic treatment was 70.9% (24.7 ± 2.1 versus 17.5 ± 1.5 ×104/L, Z = 2.81; P = 0.005), and after 1 year the main group and the comparison group on the plasma content of desquamated endothelial cells (P <0.001) differed. CONCLUSION (1) The combined use of magnesium aspartate and L-carnitine, in addition to the basic 12-month treatment, prevents the progression of HVD and provides an effective reduction of damaged endothelium in type 2 diabetic HD patients. (2) Long-term modified treatment may reduce the cardiovascular risk in these subjects.