Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006–2016

• Published in: Journal of clinical medicine Vol. 9; no. 11; p. 3578
• Main Authors: Lin, Min-Hao, Yang, Huang-Yu, Yen, Chieh-Li, Wu, Chao-Yi, Jenq, Chang-Chyi, Kuo, George, Peng, Wei-Sheng, Liu, Jia-Rou, Tian, Ya-Chung, Yang, Chih-Wei, Anderson, Gerard F., See, Lai-Chu
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 06.11.2020; MDPI
• Subjects: Clinical medicine; Cohort analysis; Diabetes; Glucose; Health insurance; Heart attacks; Heart failure; Hospitalization; Hypoglycemia; Infections; Kidney diseases; Medical prognosis; Mortality; Patients; Population; Survival analysis; Taiwan
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9113578

While pioglitazone reduces insulin resistance and hepatic gluconeogenesis effectively in patients with type 2 diabetes mellitus (T2DM), these benefits remained controversial in patients with end stage renal disease (ESRD). We compared major adverse cardiac cerebrovascular events (MACCEs) and mortality (overall, infection-related, and MACCE-related) of pioglitazone to that of dipeptidyl peptidase 4 inhibitors (DPP4-inhibitors) in patients with T2DM and ESRD. From Taiwan’s national health insurance research database (NHIRD), 647 pioglitazone users and 6080 DPP4-inhibitors users between 1 April 2006 and 31 December 2016 were followed from the 91th date after the ESRD certification until the study outcomes, independently; withdraw from the NHI program, death, or 31 December 2017, whichever came first. After weighting, risks of MACCEs (10.48% vs. 12.62% per person-years, hazard ratio (HR): 0.85, 95% (CI): 0.729–0.985) and all-cause mortality (12.86% vs. 13.22% per person-years, (HR): 0.88, 95% (CI): 0.771–0.995) are significantly lower in pioglitazone group. Subgroup analysis found lower MACCEs risk in the pioglitazone users without insulin therapy (6.44% vs. 10.04% (HR): 0.59, 95% (CI): 0.42–0.82) and lower MACCEs related death (2.76% vs. 3.84% (HR): 0.61, 95% (CI): 0.40–0.95) in the pioglitazone group with dyslipidemia, when comparing with DPP4-inhibitors users. Pioglitazone is associated with lower all-cause mortality and MACCEs in diabetic patients with ESRD, compared to DPP4-inhibitors. These benefits were even more significant in the non-insulin users and patients with dyslipidemia.