Thiazolidinedione Safety and Efficacy in Ambulatory Patients Receiving Hemodialysis

Harold J. Manley, Pharm.D., Nicole M. Allcock, Pharm.D.

Disclosures

Pharmacotherapy. 2003;23(7) 

In This Article

Results

Medical records were reviewed for 40 patients receiving hemodialysis; 26 were men, 14 women; 15 were receiving rosiglitazone therapy, 25 pioglitazone. Diabetes mellitus was the cause of ESRD in 37 (92.5%) patients; two of the remaining three had hypertension and one had glomerulonephritis. Mean ± SD age of the patients was 64.8 ± 11.5 years (range 46-85 yrs). The men were older than the women (mean ± SD age 67.65 ± 11.43 and 59.58 ± 10.6 yrs, respectively, p=0.03). No statistical difference was observed between the thiazolidinedione agent prescribed regarding patient age (mean ± SD age of patients receiving rosiglitazone and pioglitazone was 63.79 ± 11.8 and 64.63 ± 11.02 yrs, respectively, p=0.824). Sixteen patients had a history of peripheral vascular disease, and 14 had a history of chronic heart failure. All patients had anuria.

Table 1 provides combined data for rosiglitazone and pioglitazone regarding the effect of thiazolidinedione on interdialytic weight change, A1C, hematocrit, mean corpuscular volume, transferrin saturation, ferritin, erythropoietin dose, and blood pressure. Three hospitalizations (for two patients receiving rosiglitazone and one receiving pioglitazone) for chronic heart failure fluid overload occurred during the study period (p=0.555). As expected, administration of an oral hypoglycemic agent reduced A1C values (from 8.59 ± 2.18% before to 7.98 ± 2.07% 3 months after the start of thiazolidinedione therapy, p=0.05). No changes in insulin or any other hypoglycemic agent was recorded during the study period. Surprisingly, systolic and diastolic blood pressures were statistically lower 3 months after the start of therapy (change in systolic -5.57 ± 12.09 mm Hg, p=0.01; change in diastolic -3.24 ± 6.17 mm Hg, p=0.002). No statistically significant change was observed in any other parameter with combined data.

Analysis of a specific agent's effects on the various parameters yielded nonsignificant results except for the effect of rosiglitazone on interdialytic weight gain and hematocrit. Interdialytic weight gain in patients receiving rosiglitazone increased from 3.6 ± 1.47 kg at baseline to 3.97 ± 1.25 kg after the start of therapy (p=0.0032). Patients receiving rosiglitazone experienced a statistically significant decrease in hematocrit after the start of therapy (baseline 34.89% ± 3.89% vs 34.0% ± 3.44% after 3 mo of therapy, p=0.024). No difference was detected between rosiglitazone or pioglitazone effects on any other parameter (data not shown).

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