Pioglitazone For Diabetic Nephropathy: A Systemetic Review

Objective To assess the efficiency and safety of Pioglitazone for diabetic nephropathy.Methods We search PUBMED,EMBASE,Cochrane library,CBM,CNKI up to December 2010.To evaluate the quality of randomized controlled trials assessing Pioglitazone for diabetic nephropathy.And the extracted data were calculated by the Cochrane Collaboration's software RevMan 5.0.Result Twelve trials were involving 449 participants with diabetic nephropathy.There were 233 participants in Pioglitazone group and 216 participants in control group.The results of Meta-analysis showed:(1)In 3rd stage DN,Pioglitazone showed more significant than conventional therapy group in reducing UAER[P<0.00001,SMD=93.93,95%CI(86.44,101.41)]and more significant in reducing MAU [P<0.0001,SMD=18.58,95%CI(9.94,27.23)].(2) But Pioglitazone treatment showed no statistic significant diffference in reducing SCR[P=0.52,SMD=1.17,95%CI(-2.36,4.71)] and CCR[P=0.61,SMD=-1.12,95%CI(-5.45,3.20)] the same in 3rd stage DN.(3) In 4rd stage DN,Pioglitazone showed more significant than conventional therapy group in reducing UPE[P<0.00001,SMD=1.21,95%CI(1.05,1.37)] (4) Compere with conventional therapy group, Pioglitazone showed significantly positive effect on the improvement of ISI[P<0.00001,SMD=1.11 ,95%CI(1.01 ,1.22)].(5) Pioglitazone can effectively reduce blood LDL-C [P=0.0006,SMD=0.82, 95%CI(0.35 , 1.29)],TG [P=0.003 , SMD=0.94 , 95%CI(0.31 , 1.56)],TC [P<0.00001,SMD=1.66,95%CI (1.15, 2.18)]level.And the treatment show significant to HDL [P=0. 007,SMD=0.09,95%CI (0.02,0.16)]. (6)Adverse events were mentioned in two of eight studies.One study reported adverse events as hypoglycemia and significant weight gain. The other one reported no adverse event occurred.All but only one trial had a more than 24 weeks duration,so long-term efficacy and safety could not be evaluated.Conclusions Pioglitazone reduces renal UAER,MAU and UPE, delaying the progress of DN. Pioglitazone is effective to improvement insulin sensitivity ,regulate glucose and lipid metabolism and thus to protect the kidney. But we requires more studies of larger size to evaluate the patients in the Cardiovascular safety.