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EFFECT OF THIAZOLIDINEDIONES ON ALBUMINURIA AND PROTEINURIA IN DIABETES: A META-ANALYSIS: PP.9.350

Objective: To evaluate the effect of thiazolidinediones on urinary albumin and protein excretion in patients with diabetes mellitus. Design and Methods: A systematic literature search of MEDLINE/PubMed, EMBASE and Cochrane CENTRAL databases was performed to identify randomised controlled trials published until September 2009 comparing the effect of rosiglitazone or pioglitazone to placebo or other antidiabetic drugs. Two investigators independently extracted data on study and patient characteristics, study quality and outcomes of interest. Weighted mean differences (WMD) and standardized mean differences (SMD) for the change in the levels of urinary albumin or protein excretion between the thiazolidinedione and control groups were calculated using random-effect models. Results: Of the 171 originally identified studies, 15 studies (5 with rosiglitazone and 10 with pioglitazone), involving 2860 patients were included in the analysis. In subjects with baseline normo- or microalbuminuria the proportional change between thiazolidinedione and control groups in urinary albumin excretion measured by time-specified urine collections was −64.77% (95% CI: −75.6% to −53.94%) and the change in albumin to creatinine ratio was −24.78% (95% CI: −39.59% to −9.96%). Overall, in subjects with normo- and microalbuminuria thiazolidinedione treatment was associated with a significant reduction in urinary albumin excretion (SMD: −0.63 units of SD, 95% CI: −0.83 to −0.43). Similarly, thiazolidinediones were associated with a significant reduction in urinary protein excretion (SMD: −1.11 units of SD, 95% CI: −1.79 to −0.42). Conclusions: Treatment with thiazolidinediones significantly reduces the levels of urinary albumin and protein excretion in patients with diabetes. This finding calls for clinical trials with hard renal outcomes to elucidate a possible beneficial effect of thiazolidinediones on diabetic nephropathy.