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Meta-Analysis
. 2017 May 11;7(1):1717.
doi: 10.1038/s41598-017-01965-0.

Efficacy and safety of thiazolidinediones in diabetes patients with renal impairment: a systematic review and meta-analysis

Wen Wang  1 , Xu Zhou  1   2 , Joey S W Kwong  1   3 , Ling Li  1   3 , Youping Li  1   3 , Xin Sun  4   5   6
Affiliations
Meta-Analysis

Efficacy and safety of thiazolidinediones in diabetes patients with renal impairment: a systematic review and meta-analysis

Wen Wang et al. Sci Rep. .

Abstract

We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of TZDs in treatment of diabetes mellitus patients with renal impairment. We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs), cohort studies, and case-control studies that investigated the effects of TZDs in patients with diabetes and renal impairment were eligible. Outcomes included glycosylated hemoglobin, fasting plasma glucose, serum lipids, and patient-important outcomes (i.e. hypoglycemia, weight, edema, cardiovascular events and mortality). 19 RCTs and 3 cohort studies involving 21,803 patients with diabetes and renal impairment were included. Meta-analysis of RCTs showed that TZDs could significantly reduce HbA1c (MD -0.64, 95%CI -0.93 to -0.35), FPG (MD -26.27, 95%CI -44.90 to -7.64) and increase HDL levels (MD 3.70, 95%CI 1.10, 6.29). TZDs could increase weight (MD 3.23, 95% CI 2.29 to 4.16) and risk of edema (RR 2.96, 95% CI 1.22 to 7.20). Their effects on risk of hypoglycemia (RR 1.46, 95% CI 0.65 to 3.29), heart failure (RR 0.64, 95% CI 0.15 to 2.66), angina (RR 1.45, 95% CI 0.23 to 8.95) and all-cause mortality (RR 0.40, 95% CI 0.08 to 2.01) are uncertain. Results from cohort studies were similar to RCTs.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of article selection.
Figure 2
Figure 2
Change in HbA1c among patients with diabetes mellitus and renal impairment receiving TZDs versus control from RCTs.
Figure 3
Figure 3
Change in FPG among patients with diabetes mellitus and renal impairment receiving TZDs versus control from RCTs.
Figure 4
Figure 4
Changes in serum lipids and lipoproteins among patients with diabetes mellitus and renal impairment receiving TZDs versus control from RCTs. (A) Change in triacylglycerol (TG), (B) Change in total cholesterol (TC), (C) Change in low-density lipoprotein (LDL), (D) Change in high-density lipoprotein (HDL).
Figure 5
Figure 5
Change in weight among patients with diabetes mellitus and renal impairment receiving TZDs versus control from RCTs.
Figure 6
Figure 6
Risk of edema in patients with diabetes mellitus and renal impairment for the TZDs versus control groups from RCTs.
See this image and copyright information in PMC

References

    1. IDF DIABETES ATLAS. http://www.diabetesatlas.org/.
    1. National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis60, 850–886, doi:10.1053/j.ajkd.2012.07.005 (2012). - PubMed
    1. Abe M, Okada K, Soma M. Antidiabetic agents in patients with chronic kidney disease and end-stage renal disease on dialysis: metabolism and clinical practice. Curr Drug Metab. 2011;12:57–69. doi: 10.2174/138920011794520053. - DOI - PubMed
    1. Tuttle KR, et al. Diabetic kidney disease: a report from an ADA Consensus Conference. Am J Kidney Dis. 2014;64:510–533. doi: 10.1053/j.ajkd.2014.08.001. - DOI - PubMed
    1. Shah P, Mudaliar S. Pioglitazone: side effect and safety profile. Expert Opin Drug Saf. 2010;9:347–354. doi: 10.1517/14740331003623218. - DOI - PubMed

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