Brunelli Steven M, Thadhani Ravi, Ikizler T Alp, Feldman Harold I
Renal, Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Kidney Int. 2009 May;75(9):961-8. doi: 10.1038/ki.2009.4. Epub 2009 Feb 4.
Cardiovascular mortality is especially high among dialysis patients with diabetes, as is morbidity due to protein energy wasting. Given that both of these factors may be decreased by thiazolidinedione treatment, we studied the effect of thiazolidinedione use on survival among chronic dialysis patients in a national cohort of 5290 incident dialysis patients with diabetes. Thiazolidinedione use was assessed according to prescription data, and the analyses were stratified based on insulin use due to observed interaction. In the primary analysis, thiazolidinedione treatment was associated with significantly lower all-cause mortality among insulin-free but not insulin-requiring subjects, with adjusted hazards ratios of 0.53 (0.31-0.89) and 0.82 (0.46-1.47) respectively. Sensitivity analyses found the findings to be robust with respect to confounding by indication, severity of the diabetes, potential reverse causality, and time varying exposure patterns. The mechanism of this decline in all-cause mortality will need to be examined after these studies are confirmed.
在患有糖尿病的透析患者中，心血管死亡率尤其高，因蛋白质能量消耗导致的发病率也是如此。鉴于噻唑烷二酮治疗可能会降低这两个因素，我们在一个包含5290名新发糖尿病透析患者的全国队列中，研究了噻唑烷二酮的使用对慢性透析患者生存率的影响。根据处方数据评估噻唑烷二酮的使用情况，并基于观察到的相互作用，根据胰岛素使用情况对分析进行分层。在初步分析中，噻唑烷二酮治疗与无胰岛素治疗但非胰岛素依赖型受试者的全因死亡率显著降低相关，校正风险比分别为0.53（0.31 - 0.89）和0.82（0.46 - 1.47）。敏感性分析发现，在指示性混杂、糖尿病严重程度、潜在的反向因果关系和随时间变化的暴露模式方面，研究结果具有稳健性。在这些研究得到证实后，需要对全因死亡率下降的机制进行研究。
