***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Statins have multiple effects , including anti-inflammatory actions , lowering C-reactive protein levels , and reducing coronary events . We performed a post hoc analysis of the r and omized placebo-controlled 4D Study that had evaluated the efficacy and safety of atorvastatin in 1255 patients with type 2 diabetes mellitus who were on maintenance hemodialysis . Here we determined the relationship between atorvastatin treatment , C-reactive protein , and the outcome of patients who had pre-specified and adjudicated endpoints of all-cause mortality , composite vascular endpoint , myocardial infa rct ion , sudden death , and stroke .  Atorvastatin had no significant effect on the risk of composite vascular endpoint or death relative to placebo in any quartile of baseline C-reactive protein . These baseline levels were not significantly different between the treated and placebo group and remained stable at 6 months on atorvastatin but significantly increased in those patients on placebo . All of the patients with baseline C-reactive protein in the fourth quartile had a significantly increased risk of deaths and in composite vascular endpoint compared to patients in the first quartile . The mean value of two consecutive C-reactive protein measurements was associated with significant increases in the risk of sudden death , stroke , all-cause mortality and composite vascular endpoint . Our results show that C-reactive protein was highly predictive of outcome , but atorvastatin treatment was not associated with reduced relative risks in the composite vascular endpoint or mortality in patients on hemodialysis with or without inflammation Since carnitine deficiency has been reported in some patients undergoing maintenance hemodialysis , we studied the effects of intravenous infusion of L-carnitine or placebo at the end of each dialysis treatment . The trial , which lasted seven months ( one month baseline , 6 months treatment ) was multicenter , double blind , placebo controlled , and r and omized . Eighty-two long-term hemodialysis patients , who were given either carnitine ( N = 38 ) or placebo ( N = 44 ) , completed this study . In each group , clinical and biochemical parameters during treatment were compared with baseline values . Intra-dialytic hypotension and muscle cramps were reduced only in the carnitine treated group , while improvement in post-dialysis asthenia was noticed in both carnitine and placebo groups . Maximal oxygen consumption , measured during a progressive work exercise test , improved significantly in the carnitine group ( 111 + /- 50 ml/min . P less than 0.03 ) and was unchanged in the placebo group . L-carnitine treatment was associated with a significant drop in pre-dialysis concentrations of serum urea nitrogen , creatinine and phosphorus ( means + /- SEM , 101 + /- 4.5 to 84 + /- 3.9 , 16.7 + /- 0.67 to 14.7 + /- 0.64 , and 6.4 + /- 0.3 to 5.5 + /- 0.4 mg/dl , respectively , P less than 0.004 ) . No significant changes in any of these variables were noticed in the placebo group . Mid-arm circumference and triceps skinfold thickness were measured in 11 carnitine and 13 placebo treated patients . Calculated mid-arm muscle area increased in the carnitine patients ( 41.37 + /- 2.68 to 45.6 + /- 2.82 cm2 , P = 0.05 ) and remained unchanged in the placebo patients . ( ABSTRACT TRUNCATED AT 250 WORDS It has been reported that treatment with L-carnitine at a daily dose of 3 g orally may cause a rise in platelet aggregation and serum triglyceride concentration in hemodialyzed patients . The present double-blind cross-over study has been performed to evaluate the influence of L-carnitine when compared with placebo on platelet aggregation and plasma concentrations of various factors involved in platelet activation . In addition , the concentration of triglycerides , cholesterol and HDL-cholesterol has been evaluated . 18 uremic patients on maintenance hemodialysis for at least 1 year were r and omly allocated either to a control group receiving placebo or to a group treated with L-carnitine . Statistical analysis performed by means of ANOVA did not show any significant change in the serum concentration of cholesterol , HDL-cholesterol and triglycerides . Furthermore , platelet aggregation tests ( performed with adenosine 5'-diphosphate , epinephrine , thrombin and collagen ) and plasma beta-thromboglobulin concentration did not show any statistically significant difference . In addition , the plasma concentration of several coagulation markers , such as factor VIIIc , antithrombin III , alpha 2-antiplasmin , and fibrinopeptide A , did not show any significant variation . The results suggest that under our experimental conditions L-carnitine neither increases the risk of thromboembolism nor alters the serum lipid content in uremic patients on chronic hemodialysis Hypertriglyceridemia is often present in chronically uremic patients treated with maintenance hemodialysis and has been considered a risk factor in the accelerated development of atheroma . Muscle carnitine content is low in hemodialyzed patients . This abnormality may help to explain the myopathy and cardiomyopathy often observed in these subjects . In addition , carnitine might play a role in the hypertriglyceridemia in renal failure . Carnitine , which is necessary for fatty acid oxidation , has been recently reported to lower serum triglycerides in patients with type IV hyperlipoproteinemia .  Carnitine was administered intravenously three times weekly at the end of hemodialysis in eight patients .  Carnitine was given in 0.5 g doses for 8 weeks and then in 1.0 g doses for 6 additional weeks . There was a significant decrease in serum triglycerides at the end of treatment . In contrast , serum lipids in eight hemodialysis patients receiving placebo  did not change significantly . Carnitine administration does not cause any side effect except some euphoria . These results suggest that carnitine may be effective in the treatment of hypertriglyceridemia in dialysis patients A group of 14 uremic patients on intermittent hemodialysis was admitted to a cross-over double-blind trial in order to evaluate serum and muscle carnitine levels before and after 60 days of L-carnitine oral ( 2 g/day ) treatment . The morphology of muscle fragments was studied by light and electron microscopy . Symptoms ( asthenia , cramps ) occurring during hemodialysis were also recorded . After L-carnitine treatment the blood and muscle levels of the metabolite increased simultaneously to reduced asthenia and cramps . Morphological examination of the muscle of 13 of 14 patients did not reveal any pre- or posttreatment pathological alterations . The presence of nemaline rods was morphologically diagnosed in only one case and was no longer observed at the second biopsy at 2 months of L-carnitine treatment BACKGROUND Carnitine insufficiency is responsible for various co-morbid conditions in maintenance hemodialysis ( MHD ) patients .  L-carnitine supplementation is expected to improve the quality of life ( QoL ) of patients on MHD . AIMS To study the effect of L-carnitine supplementation on QoL of Indian patients on MHD . SETTING AND DESIGN This was a single ( patient ) blind , r and omized , placebo-controlled clinical trial conducted on patients on MHD attending hemodialysis unit of the study center . MATERIAL S AND METHODS Twenty patients on MHD suffering from hemodialysis-related symptoms were r and omly assigned to receive intravenous L-carnitine 20 mg/kg or placebo after every dialysis session for 8 weeks . SF36 ( Short Form with 36 questions ) score for QoL , laboratory investigations and dialysis related symptoms were recorded at baseline and after 8 weeks . Improvement in QoL , laboratory parameters and dialysis related symptoms in the two groups after 8 weeks was compared . STATISTICAL ANALYSIS USED Depending on normality of data , unpaired T test or Mann Whitney U test was used for comparison of change ( 8 weeks-baseline ) in SF36 scores and laboratory parameters observed in the two groups . RESULTS L-carnitine supplementation increased total SF36 score by 18.29 + /- 12.71 ( 95 % CI : 10.41 to 26 ) while placebo result ed in reduction in total SF36 score by 6.4 + /- 16.39 ( 95 % CI : -16.59 to 3.73 ) . L-carnitine also result ed in significant increase in hemoglobin and serum albumin and decrease in serum creatinine as compared to placebo . More patients were relieved of dialysis related symptoms in L-carnitine group . CONCLUSION Intravenous L-carnitine supplementation improves QoL in patients on MHD INTRODUCTION Dyslipidemia and high serum lipoprotein(a ) are among the risk factors for cardiovascular diseases in hemodialysis patients .  Statins as a first line of therapy in hyperlipidemia does not always reduce the serum lipoprotein(a ) level . Several studies have reported the lipid-lowering effects of carnitine and coenzyme Q10 in hemodialysis patients . This study was design ed to investigate the effects of carnitine and coenzyme Q10 on serum lipid profile and lipoprotein(a ) level in maintenance hemodialysis patients . MATERIAL S AND METHODS This was a r and omized placebo-controlled trial . We studied on hemodialysis patients who were on treatment with atorvastatin or lovastatin to assess the efficacy of supplement therapy . They were divided into 4 groups to receive carnitine , coenzyme Q10 , both carnitine and coenzyme Q10 , and placebo . After a 3-month experiment , blood sample s were collected to measure serum levels of lipoprotein(a ) , triglyceride , total cholesterol , high-density lipoprotein cholesterol and low-density lipoprotein cholesterol . RESULTS Fifty-two hemodialysis patients , 27 men and 25 women , completed the course of the study . Three months after supplement therapy , serum levels of lipoprotein(a ) reduced significantly in the carnitine , coenzyme Q10 , and combination groups compared to the baseline values and the 3-month value of lipoprotein(a ) in the placebo group ( P = .01 ) . Serum levels of triglyceride and other lipoproteins did not significantly alter . CONCLUSIONS Our study showed that supplementation with carnitine and coenzyme Q10 could reduce serum levels of lipoprotein(a ) in maintenance hemodialysis patients treated with statins Left ventricular function was non-invasively studied in 28 r and omly selected haemodialysis patients before and after administration of L-carnitine , 2 g i.v . three times per week or saline  in a double blind design ed study over a six-week period . Cardiac function variables showed no relationship to muscle ( vastus lateralis ) and plasma carnitine concentrations . No apparent deficiency in muscle carnitine was found , whereas total plasma carnitine was lower in female patients than in female controls , p less than 0.002 . The echocardiographic left ventricular end-diastolic diameter was initially increased in about one third and the ejection fraction was depressed in about one fifth of the patients . An increased A : H ratio was found in 15 % . Systolic time intervals were deranged in 30 % of the patients . After carnitine administration , marked increases of muscle and plasma carnitine levels were found , p less than 0.01 , but no effects were recorded in any of the cardiac tests . Muscle carnitine increased from 14.6 mmol/kg dry weight to a median of 23.7 mmol/kg . We found no support for the hypothesis that carnitine depletion is responsible for cardiac dysfunction in haemodialysis patients BACKGROUND Statins reduce the incidence of cardiovascular events in persons with type 2 diabetes mellitus . However , the benefit of statins in such patients receiving hemodialysis , who are at high risk for cardiovascular disease and death , has not been examined . METHODS We conducted a multicenter , r and omized , double-blind , prospect i ve study of 1255 subjects with type 2 diabetes mellitus receiving maintenance hemodialysis who were r and omly assigned to receive 20 mg of atorvastatin per day or matching placebo . The primary end point was a composite of death from cardiac causes , nonfatal myocardial infa rct ion , and stroke . Secondary end points included death from all causes and all cardiac and cerebrovascular events combined . RESULTS After four weeks of treatment , the median level of low-density lipoprotein cholesterol was reduced by 42 percent among patients receiving atorvastatin , and among those receiving placebo it was reduced by 1.3 percent . During a median follow-up period of four years , 469 patients ( 37 percent ) reached the primary end point , of whom 226 were assigned to atorvastatin and 243 to placebo ( relative risk , 0.92 ; 95 percent confidence interval , 0.77 to 1.10 ; P=0.37 ) . Atorvastatin had no significant effect on the individual components of the primary end point , except that the relative risk of fatal stroke among those receiving the drug was 2.03 ( 95 percent confidence interval , 1.05 to 3.93 ; P=0.04 ) . Atorvastatin reduced the rate of all cardiac events combined ( relative risk , 0.82 ; 95 percent confidence interval 
    Output:
    
This meta- analysis failed to confirm the previous findings regarding the effects of l-carnitine on hemoglobin and the erythropoietin dose but showed that l-carnitine significantly decreased serum LDL and CRP .
The extent of the decrease in LDL was not clinical ly relevant , whereas the significant decrease in CRP was both statistically and clinical ly relevant .