Enhanced Outcomes in Type 2 Diabetes Patients with Acute Kidney Disease Through Thiazolidinedione

Context: Patients with diabetes are prone to acute kidney injury with the potential transition to chronic kidney disease. Few studies have investigated the role of thiazolidinedione (TZD) in these patients under acute kidney disease (AKD) phase.

Objective: We sought to examine whether using TZD during AKD could reduce the risk of future major adverse outcomes.

Design and methods: We employed the TriNetX platform before September 30, 2022, for TZD administration to patients with type 2 diabetes mellitus (T2DM) within 90 days of an AKD diagnosis. Clinical endpoints include the risk of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE). Hazard ratios (HRs) and 95% confidence intervals were calculated with 1:1 ratio propensity score matching (PSM).

Results: Among the cohort of 263,101 patients with AKD and T2DM, we identified 2,723 individuals (1.03%) who were TZD users during the AKD period. After PSM, the final cohort of TZD users included 2,555 individuals, with 53.82% being male and a mean age of 64.0 ± 13.5 years. Over a median follow-up period of 1.5 years, the TZD group exhibited a lower risk across various outcomes, with hazard ratios (HR) of 0.68 (95% CI, 0.57-0.81) for all-cause mortality, 0.68 (95% CI, 0.58-0.80) for MACE, and 0.75 (95% CI, 0.66-0.86) for MAKE.

Conclusion: TZD demonstrated a notable reduction in mortality, cardiovascular events, and kidney-related adverse events among T2DM patients with AKD. These findings suggest a potential benefit of TZD usage for managing cardiovascular events in T2DM patients with AKD.