Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Pioglitazone is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006-2016

Version 1 : Received: 30 September 2020 / Approved: 1 October 2020 / Online: 1 October 2020 (15:41:50 CEST)

How to cite: Lin, M.; Yang, H.; Yen, C.; Wu, C.; Jenq, C.; Kuo, G.; Peng, W.; Liu, J.; Tian, Y.; Yang, C.; Anderson, G.; See, L. Pioglitazone is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006-2016. Preprints 2020, 2020100021 (doi: 10.20944/preprints202010.0021.v1). Lin, M.; Yang, H.; Yen, C.; Wu, C.; Jenq, C.; Kuo, G.; Peng, W.; Liu, J.; Tian, Y.; Yang, C.; Anderson, G.; See, L. Pioglitazone is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006-2016. Preprints 2020, 2020100021 (doi: 10.20944/preprints202010.0021.v1).

Abstract

While pioglitazone reduces insulin resistance and hepatic gluconeogenesis effectively in patients with T2DM, these benefits remained controversial in patients with ESRD. We compared MACCEs and mortality (overall, infection-related, and MACCE-related) of pioglitazone to that of DPP4-inhibitors in patients with T2DM and ESRD. From Taiwan’s national health insurance database, 647 pioglitazone users and 6080 DPP4-inhibitors users between April 1st, 2006 and December 31th, 2016 were followed from the 91th date after the ESRD certification till study outcomes, independently; withdraw from the NHI program, death, or Dec. 31th, 2017. After weighting, risks of MACCEs (10.48% vs 12.62% per person-years, [HR]: 0.85, 95% [CI]: 0.729–0.985) and all-cause mortality (12.86% vs 13.22% per person-years, [HR]: 0.88, 95% [CI]: 0.771–0.995) are significantly lower in pioglitazone group. Subgroup analysis found lower MACCEs risk in the pioglitazone users without insulin therapy (6.44% vs 10.04% [HR]: 0.59, 95% [CI]: 0.42–0.82) and lower MACCEs related death (2.76% vs 3.84% [HR]: 0.61, 95% [CI]: 0.40–0.95) in the pioglitazone group with dyslipidemia, when comparing with DPP4-inhibitors users. Pioglitazone is associated with lower all-cause mortality and MACCEs in diabetic patients with ESRD, compared to DPP4-inhibitors. These benefits were further significant in the non-insulin users and patients with dyslipidemia.

Subject Areas

Pioglitazone; DPP4-inhibitor; ESRD; Cardiovascular outcome; Mortality

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