Strict glycaemic control in diabetic patients with CKD or ESRD: beneficial or deadly?

Abstract

The evidence in CKD Information about the effect of strict glycaemic control on outcome in diabetic patients with CKD is very limited. In the PROactive study (Prospective Pioglitazone Clinical Trial in Macrovascular Events), patients with type 2 diabetes and CKD (n = 597; 11.6% of the 5154 patients) had a particularly high CV risk and cardiovascular disease (CVD) [7]. The incidence of the combined end point (non-fatal myocardial infarction, stroke and death) was 18.3% in patients with CKD compared with 11.5% in patients without CKD (HR 1.65; P < 0.0001). In addition, all-cause mortality was 10.9% compared to 5.9% (HR 1.86) in those without CKD. Remarkably, patients who had CKD and were treated with pioglitazone were less likely to reach the combined end point (HR 0.66; P < 0.001) independently of the severity of renal impairment [7]. Since at study end the HbA1c difference between pioglitazone and placebo was only 0.5% (6.9 vs 7.4%), presumably a variety of well-documented anti-atherogenic effects of pioglitazone [8] were responsible for CV protection in diabetic patients presenting with CVD.