Diabetes, Endstage Renal Disease
Conditions
Keywords
PPAR-gamma, diabetic, kidney disease, atherosclerosis
Brief summary
To test the hypothesis that PPAR-gamma agonist, rosiglitazone, induces carotid plaque regression in diabetic ESRD patients on maintenance PD via its anti-inflammatory property.
Detailed description
End-stage renal disease (ESRD) patients are at an increased risk of accelerated atherosclerosis and cardiovascular morbidity and mortality. Non-traditional risk factors such as inflammation and insulin resistance have important contributions to accelerated atherosclerosis in ESRD patients receiving long-term peritoneal dialysis (PD). The peroxisome proliferator-activated receptor-g (PPAR-g) is a member of the nuclear receptor family of ligand-dependent transcription factors. Activation of the PPAR-g has been shown in both clinical and experimental studies to have anti-inflammatory and anti-atherosclerotic properties other than insulin-sensitizing effects. Recent study also showed that PPAR-g agonists reduce plaque inflammation by inhibiting the activation of proinflammatory genes responsible for plaque development and growth. Hence, this study aims to examine the effects of PPAR-g activation on the progression of carotid plaque in diabetic ESRD patients receiving long-term PD using high-resolution magnetic resonance imaging (MRI).
Interventions
oral Pioglitazone 15mg daily for 12 weeks, then 30mg daily for 36 weeks
Placebo comparator
Sponsors
Study design
Eligibility
Inclusion criteria
* Diabetic ESRD patients receiving long-term PD treatment, with carotid plaque (defined as focal intima-media thickening \>1mm) present on screening ultrasonography * Patients who provide informed consent for the study
Exclusion criteria
* Patients with systemic inflammatory disease such as systemic lupus erythematosus * Patients with chronic liver disease or cirrhosis * Patients with current active malignancy * Patients with chronic rheumatic heart disease or congenital heart disease * Patients with poor general condition * Patients with plan for living related kidney transplant within coming 1 year * Patients with pre-existing class III/IV heart failure, * Patients with recurrent hypoglycemia * Patients already on glitazone treatment * Female patients with pregnancy * Patients with contraindications for MRI examination including those with pacemaker or metallic implant.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in carotid plaque volume | 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Change in inflammatory markers include C-reactive protein, interleukin-6, adiponectin, metalloproteinases | 12 months |
Countries
Hong Kong