The efficacy of pioglitazone for renal protection in diabetic kidney disease

• Published in: PloS one Vol. 17; no. 2; p. e0264129
• Main Authors: Ho, Chao-Chung, Yang, Yi-Sun, Huang, Chien-Ning, Lo, Shih-Chang, Wang, Yu-Hsun, Kornelius, Edy
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.02.2022; Public Library of Science (PLoS)
• Subjects: Aged; Albuminuria - epidemiology; Albuminuria - prevention & control; Biology and Life Sciences; Cardiovascular disease; Care and treatment; Creatinine; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetic nephropathies; Diabetic Nephropathies - etiology; Diabetic Nephropathies - metabolism; Diabetic Nephropathies - pathology; Diabetic Nephropathies - prevention & control; Diabetic nephropathy; Endocrinology; Enrollments; Epidermal growth factor receptors; Female; Glomerular Filtration Rate; Glucose; Hemodialysis; Hospitals; Humans; Hypertension; Hypoglycemic Agents - therapeutic use; Internal medicine; Kidney - drug effects; Kidney - pathology; Kidney diseases; Kidney transplantation; Kidneys; Male; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Patients; Pioglitazone; Pioglitazone - therapeutic use; Retrospective Studies; Taiwan - epidemiology; Transplantation; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264129

There is limited information on the efficacy of pioglitazone in diabetic kidney diseases (DKD). We evaluated whether pioglitazone exerts renal-protective effects in DKD patients. We designed a retrospective cohort study, which included 742 type 2 diabetes mellitus (T2DM) patients with DKD in Taiwan, with eGFR between 30 and 90 ml/min/1.73 m2 and UACR level 300-5000 mg/g. Patients not meeting the target range for HbA1c (above 7%) were given additional medication with pioglitazone (n = 111) or received standard care (non-pioglitazone group, n = 631). The primary endpoint was the occurrence of composite renal endpoints, which was defined as sustained eGFR<15 ml/min/1.73 m2 (confirmed by two measurements within 90 days); doubling of serum creatinine (compared to baseline); and the presence of hemodialysis or renal transplantation. The median follow-up duration was two years. At baseline, the mean HbA1C levels in the pioglitazone and non-pioglitazone groups were 8.8% and 8.1%, respectively; mean ages were 64.4 and 66.2 years old, respectively; diabetes durations were 14.3 and 12.3 years, respectively. Baseline eGFR showed no significant difference between the pioglitazone and non-pioglitazone groups (55.8 and 58.8 mL/min/1.73 m2, respectively). In terms of gender, 63% of patients were male in the pioglitazone group compared with 57% in the non-pioglitazone group. Pioglitazone use did not reduce the risk of composite renal endpoints in DKD patients (HR: 0.97, 95% CI = 0.53-1.77), including persistent eGFR<15 ml/min/1.73 m2 (HR = 1.07, 95% CI = 0.46-2.52), doubling of serum creatinine (HR = 0.97, 95% CI = 0.53-1.77), or ESRD (HR = 2.58, 95% CI = 0.29-23.04). The results were not changed after various adjustments. A non-significant albuminuria reduction was also noted after pioglitazone prescription in DKD patients. Further randomized controlled studies are needed to establish the effects of pioglitazone definitively.