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NDT Advance Access published online on October 28, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp567
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Effects of pioglitazone on subclinical atherosclerosis and insulin resistance in nondiabetic renal allograft recipients

Seung Jin Han1,2,*, Kyu Yeon Hur3,*, Yu Seun Kim4, Eun Seok Kang5,6, Soon Il Kim4, Myoung Soo Kim4, Jung Young Kwak7, Dae Jung Kim1, Sung Hee Choi8, Bong Soo Cha5,6 and Hyun Chul Lee2,5,6

1 Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon 443-721, Korea 2 Department of Medicine, Graduate School, Yonsei University, Seoul, Korea 3 Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea 4 Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea 5 Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea 6 Brain Korea 21 for Medical Science, Yonsei University College of Medicine, Seoul 120-752, Korea 7 Severance Hospital Diabetes Center, Yonsei University Medical Center, Seoul 120-752, Korea 8 Department of Internal Medicine, Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Correspondence and offprint requests to: Correspondence and offprint requests to: Hyun Chul Lee; E-mail: endohclee{at}yuhs.ac



  Abstract

Background. The aim of this study was to evaluate the effect of pioglitazone treatment on the progression of subclinical atherosclerosis and insulin resistance in renal allograft recipients with no preoperative history of diabetes.

Methods. Eighty-three patients without diabetes were randomly assigned to either the pioglitazone group or the control group. Carotid intima–media thickness (IMT), serum adiponectin level and lipid profile were assessed before transplantation and at 12 months after transplantation. Insulin secretory function and insulin resistance were evaluated by the oral glucose tolerance test.

Results. The pioglitazone group showed a significant reduction in the mean and maximum carotid IMT compared with the control group after 12 months (mean carotid IMT, 0.05 ± 0.04 vs –0.03 ± 0.07 mm, P < 0.001; maximum carotid IMT, 0.08 ± 0.05 vs –0.05 ± 0.09 mm, P < 0.001). Pioglitazone increased the adiponectin level, and the change in adiponectin was negatively correlated with carotid IMT changes. Pioglitazone treatment increased the insulin sensitivity index compared with the control group (–0.8 ± 3.1x10–2 vs +1.1 ± 3.7x10–2, P = 0.036).

Conclusions. These results suggest that pioglitazone treatment reduces the progression of carotid IMT and improves insulin resistance in renal allograft recipients without a history of diabetes.

Trial Registration. Clinicaltrials.gov Identifier: NCT00598013 [ClinicalTrials.gov]

Keywords: carotid intima–media thickness; insulin resistance; pioglitazone; renal allograft

* Seung Jin Han and Kyu Yeon Hur contributed equally to this work

Received for publication: 31. 8.08
Accepted in revised form: 28. 9.09


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