Effect of Thiazolidinediones on Renal Outcomes in Diabetic Patients with Microalbuminuria or Macroalbuminuria-A Systematic Review and Meta-analysis

Abstract

Introduction: Diabetic nephropathy (DN), has recently become the leading cause of end-stage renal disease (ESRD) in most countries, recent studies suggest that thiazolidinediones (TZDs) have renal benefits. The aim of this meta-analysis was to assess the effect of TZDs on renal outcomes in type 2 diabetic patients with microalbuminuria or macroalbuminuria. Methods: Medline, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched from 1991 to September 2017. Randomized controlled trials (RCTs) were selected to evaluate the impact of TZDs on urinary albumin, protein excretion, eGFR or Scr in diabetic patients. Weighted (WMDs) and standardized mean differences (SMDs) were used for changes in urine albumin or protein excretion, eGFR and Scr between the TZDs and control groups. Results: 26 RCTs (9 with rosiglitazone and 17 with pioglitazone) involving 8129 patients with type 2 diabetes were included in this review. Meta-analysis of RCTs showed that in patients with baseline normo- and/or microalbuminuria, the WMD of proportional changes between the TZDs and control groups in urinary albumin excretion was -64.77% (95% CI, -75.60 to -53.94) and the WMD of changes in albumin-creatinine ratio was -24.94% (95% CI, -38.83 to -11.05). Overall, in participants with normo- and/or microalbuminuria, TZDs treatment was associated with a significant decrease in urinary albumin excretion (SMD, -0.91 units of standard deviation [SD]; 95% CI, -1.19 to -0.64). Similarly, TZDs were associated with a significant decrease in urinary protein excretion in patients with macroalbuminuria (SMD, -1.units of SD; 95% CI, -1.86 to -0.27). However, TZDs treatment couldn’t effectively improve eGFR or the level of Scr in diabetic patients whether with microalbuminuria or macroalbuminuria. Conclusions: Treatment with TZDs can benefit patients with early diabetic nephropathy in absence of renal dysfunction. Disclosure Y. Qin: None. X. Wang: None. M. Zhang: None.