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Thiazolidinediones and Risk of Long-Term Dialysis in Diabetic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study.

Chen YH, Chiang MH, Liu JS, Chang YK, Kuo KL, Hung SC, Tai HL, Hsu CC, Tarng DC - PLoS ONE (2015)

Bottom Line: Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86) and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91).The results were consistent across most patient subgroups.Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.

ABSTRACT
Thiazolidinediones (TZDs) reduce urinary albumin excretion and proteinuria in diabetic nephropathy. The effect of TZDs on hard renal outcome in diabetic patients with chronic kidney disease (CKD) is unknown. We investigate the association of TZDs and risk of long-term dialysis or death in diabetic patients with advanced CKD. The nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. From January 2000 to June 2009, 12350 diabetic patients with advanced CKD (serum creatinine levels greater than 6 mg/dL but not yet receiving renal replacement therapy) were selected for the study. We used multivariable Cox regression models and a propensity score-based matching technique to estimate hazard ratios (HRs) for development of long-term dialysis and the composite outcome of long-term dialysis or death for TZD users (n=1224) as compared to nonusers (n=11126). During a median follow-up of 6 months, 8270 (67.0%) patients required long-term dialysis and 2593 (21.0%) patients died before starting long-term dialysis. Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86) and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91). The results were consistent across most patient subgroups. Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death. Further randomized controlled studies are required to validate this association.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves of study outcomes.Cumulative incidences for long-term dialysis (a) and long-term dialysis or death (b) among diabetic patients with advanced chronic kidney disease comparing TZD users vs. nonusers. TZD, thiazolidinedione.
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pone.0129922.g002: Kaplan-Meier curves of study outcomes.Cumulative incidences for long-term dialysis (a) and long-term dialysis or death (b) among diabetic patients with advanced chronic kidney disease comparing TZD users vs. nonusers. TZD, thiazolidinedione.

Mentions: During a median follow-up of 6 months (interquartile range, 4 to 11 months), 8270 (67.0%) patients required long-term dialysis and 2593 (21.0%) patients died before starting long-term dialysis. The relative short follow-up period resulted from the fact that patients with advanced CKD easily progress to end point of dialysis or death within 1 year (Fig 2). The number of events and incidence rates of long-term dialysis and the composite outcome of long-term dialysis or death are listed in Table 2. The Kaplan–Meier curves showed the cumulative incidences of long-term dialysis (Fig 2a) and long-term dialysis or death (Fig 2b) were both significantly lower in TZD users compared with nonusers (P<0.001). Table 2 demonstrated that use of TZDs in diabetic patients with advanced CKD was associated with the reduced risk for long-term dialysis with adjusted hazard ratio (HR) of 0.81 (95% confidence interval (CI), 0.75–0.87; P<0.001) and for the composite outcome of long-term dialysis or death with adjusted HR of 0.87 (95% CI, 0.81–0.92; P<0.001). The propensity score matched HRs were 0.80 (95% CI, 0.74–0.86; P<0.001) for long-term dialysis and 0.85 (95% CI, 0.80–0.91; P<0.001) for the composite outcome of long-term dialysis or death. The propensity score matched HRs of the study outcomes were also shown in subgroup analysis to minimize the residual confounding (Fig 3).


Thiazolidinediones and Risk of Long-Term Dialysis in Diabetic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study.

Chen YH, Chiang MH, Liu JS, Chang YK, Kuo KL, Hung SC, Tai HL, Hsu CC, Tarng DC - PLoS ONE (2015)

Kaplan-Meier curves of study outcomes.Cumulative incidences for long-term dialysis (a) and long-term dialysis or death (b) among diabetic patients with advanced chronic kidney disease comparing TZD users vs. nonusers. TZD, thiazolidinedione.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4470911&req=5

pone.0129922.g002: Kaplan-Meier curves of study outcomes.Cumulative incidences for long-term dialysis (a) and long-term dialysis or death (b) among diabetic patients with advanced chronic kidney disease comparing TZD users vs. nonusers. TZD, thiazolidinedione.
Mentions: During a median follow-up of 6 months (interquartile range, 4 to 11 months), 8270 (67.0%) patients required long-term dialysis and 2593 (21.0%) patients died before starting long-term dialysis. The relative short follow-up period resulted from the fact that patients with advanced CKD easily progress to end point of dialysis or death within 1 year (Fig 2). The number of events and incidence rates of long-term dialysis and the composite outcome of long-term dialysis or death are listed in Table 2. The Kaplan–Meier curves showed the cumulative incidences of long-term dialysis (Fig 2a) and long-term dialysis or death (Fig 2b) were both significantly lower in TZD users compared with nonusers (P<0.001). Table 2 demonstrated that use of TZDs in diabetic patients with advanced CKD was associated with the reduced risk for long-term dialysis with adjusted hazard ratio (HR) of 0.81 (95% confidence interval (CI), 0.75–0.87; P<0.001) and for the composite outcome of long-term dialysis or death with adjusted HR of 0.87 (95% CI, 0.81–0.92; P<0.001). The propensity score matched HRs were 0.80 (95% CI, 0.74–0.86; P<0.001) for long-term dialysis and 0.85 (95% CI, 0.80–0.91; P<0.001) for the composite outcome of long-term dialysis or death. The propensity score matched HRs of the study outcomes were also shown in subgroup analysis to minimize the residual confounding (Fig 3).

Bottom Line: Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86) and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91).The results were consistent across most patient subgroups.Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.

ABSTRACT
Thiazolidinediones (TZDs) reduce urinary albumin excretion and proteinuria in diabetic nephropathy. The effect of TZDs on hard renal outcome in diabetic patients with chronic kidney disease (CKD) is unknown. We investigate the association of TZDs and risk of long-term dialysis or death in diabetic patients with advanced CKD. The nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. From January 2000 to June 2009, 12350 diabetic patients with advanced CKD (serum creatinine levels greater than 6 mg/dL but not yet receiving renal replacement therapy) were selected for the study. We used multivariable Cox regression models and a propensity score-based matching technique to estimate hazard ratios (HRs) for development of long-term dialysis and the composite outcome of long-term dialysis or death for TZD users (n=1224) as compared to nonusers (n=11126). During a median follow-up of 6 months, 8270 (67.0%) patients required long-term dialysis and 2593 (21.0%) patients died before starting long-term dialysis. Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86) and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91). The results were consistent across most patient subgroups. Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death. Further randomized controlled studies are required to validate this association.

No MeSH data available.


Related in: MedlinePlus