School of Medicine of Chung Shan Medical University, Taichung City, Taiwan.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung City, Taiwan.
PLoS One. 2022 Feb 17;17(2):e0264129. doi: 10.1371/journal.pone.0264129. eCollection 2022.
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.
关于吡格列酮在糖尿病肾脏疾病（DKD）中的疗效，信息有限。我们评估了吡格列酮是否对 DKD 患者具有肾脏保护作用。我们设计了一项回顾性队列研究，纳入了台湾的 742 名患有 DKD 的 2 型糖尿病（T2DM）患者，他们的 eGFR 在 30 至 90ml/min/1.73m2 之间，UACR 水平为 300-5000mg/g。不符合 HbA1c 目标范围（高于 7%）的患者接受了吡格列酮（n=111）或接受了标准护理（非吡格列酮组，n=631）的附加药物治疗。主要终点是复合肾脏终点的发生，该终点定义为持续的 eGFR<15ml/min/1.73m2（在 90 天内两次测量确认）；血清肌酐加倍（与基线相比）；以及血液透析或肾移植的存在。中位随访时间为两年。基线时，吡格列酮组和非吡格列酮组的平均 HbA1C 水平分别为 8.8%和 8.1%；平均年龄分别为 64.4 岁和 66.2 岁；糖尿病病程分别为 14.3 年和 12.3 年。基线 eGFR 显示吡格列酮组和非吡格列酮组之间无显著差异（分别为 55.8 和 58.8ml/min/1.73m2）。就性别而言，吡格列酮组 63%的患者为男性，而非吡格列酮组为 57%。吡格列酮的使用并未降低 DKD 患者复合肾脏终点的风险（HR：0.97，95%CI=0.53-1.77），包括持续的 eGFR<15ml/min/1.73m2（HR=1.07，95%CI=0.46-2.52）、血清肌酐加倍（HR=0.97，95%CI=0.53-1.77）或 ESRD（HR=2.58，95%CI=0.29-23.04）。经过各种调整后，结果没有改变。在 DKD 患者中，使用吡格列酮后也观察到白蛋白尿的非显著减少。需要进一步的随机对照研究来确定吡格列酮的疗效。
