Pioglitazone Reduces Mortality and Adverse Events in Patients With Type 2 Diabetes and With Advanced Chronic Kidney Disease: National Cohort Study

Abstract

Several oral hypoglycemic agents (OHA) are not recommended for patients with advanced chronic kidney disease (CKD). Early use of supplemental insulin, which can potentially increase the risk of hypoglycemia and cardiovascular events, was noted among patients with limited choices. Pioglitazone is a thiazolidinedione, which can be safely used in patients with CKD and patients with end-stage renal disease (ESRD) without dose adjustment. Previous research has indicated that pioglitazone can improve peripheral insulin sensitivity and potentially reduce cardiovascular risks (1). However, the benefit of pioglitazone in patients with type 2 diabetes (T2D) with advanced CKD has been overlooked. Using Taiwan’s National Health Insurance Research Database (NHIRD), which covers ∼99.8% of Taiwan’s population (nearly 23.37 million) and provides comprehensive health care information, we compared the incidence of major cardiac and cerebrovascular events (MACCE) and new-onset ESRD requiring dialysis and the rate of mortality in T2D patients with advanced CKD treated with pioglitazone and the most popular OHA, dipeptidyl peptidase 4 (DPP-4) inhibitors, in this population. DPP-4 inhibitors were known for their low risk of hypoglycemia and near-neutral effect on cardiovascular outcomes (2). In this study, a total of 90,193 T2D …