Thiazolidinediones and progression of renal disease in patients with diabetes.
OBJECTIVE
Thiazolidinediones (TZDs) are used in the treatment of type 2 diabetes mellitus (T2DM) and appear to have beneficial effects on markers of cardiovascular or renal risk that are independent of glycemic control. We examined the effects of TZDs on renal survival in a predominantly black population with T2DM.


METHODS
We performed a retrospective case-control study in patients with T2DM seen in our nephrology clinic in 2001 to 2002. Cases had T2DM and were on a TZD at presentation or for >or= 6 months over follow-up. Controls were matched for sex, age, duration of T2DM, and initial creatinine. Reaching end-stage renal disease (ESRD) was the primary end point.


RESULTS
From 387 records, 43 cases (34 blacks, 31 females) and 106 controls (96 blacks, 83 females) were identified. The baseline characteristics were similar for both groups. Both groups had moderate renal disease (estimated glomerular filtration rate approximately 40-45 mL/min). Cases had lower systolic blood pressure over follow-up (p=.02), but there was no difference in glycemic control or use of insulin. Renal survival was better among cases (age- and gender-adjusted odds ratio for reaching ESRD 0.17 [95% confidence interval 0.03-0.8]; p=.03). When adjusted for systolic blood pressure over follow-up, the tendency for improved renal survival in cases remained but was no longer significant.


CONCLUSIONS
We conclude that TZDs may protect against the progression of renal disease in T2DM. Prospective studies are required to determine the effects of TZDs on renal survival in T2DM.
Department of Medicine, Wayne State University School of Medicine and the John.D.Dingell VA Medical Center, Detroit, MI, USA.
Abhijeet
A
Goyal
Errol D
ED
Crook
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D045162:Thiazolidinediones / Q000627:therapeutic use*
D045162:Thiazolidinediones