Pioglitazone improves fat distribution, the adipokine profile and hepatic insulin sensitivity in non-diabetic end-stage renal disease subjects on maintenance dialysis: a randomized cross-over pilot study

Anne Zanchi, Luc Tappy, Kim-Anne Lê, Murielle Bortolotti, Nicolas Theumann, Georges Halabi, Thierry Gauthier, Claudine Mathieu, Sylvie Tremblay, Pauline Coti Bertrand, Michel Burnier, Daniel Teta, Anne Zanchi, Luc Tappy, Kim-Anne Lê, Murielle Bortolotti, Nicolas Theumann, Georges Halabi, Thierry Gauthier, Claudine Mathieu, Sylvie Tremblay, Pauline Coti Bertrand, Michel Burnier, Daniel Teta

Abstract

Background: Fat redistribution, increased inflammation and insulin resistance are prevalent in non-diabetic subjects treated with maintenance dialysis. The aim of this study was to test whether pioglitazone, a powerful insulin sensitizer, alters body fat distribution and adipokine secretion in these subjects and whether it is associated with improved insulin sensitivity.

Trial design: This was a double blind cross-over study with 16 weeks of pioglitazone 45 mg vs placebo involving 12 subjects.

Methods: At the end of each phase, body composition (anthropometric measurements, dual energy X-ray absorptometry (DEXA), abdominal CT), hepatic and muscle insulin sensitivity (2-step hyperinsulinemic euglycemic clamp with 2H2-glucose) were measured and fasting blood adipokines and cardiometabolic risk markers were monitored.

Results: Four months treatment with pioglitazone had no effect on total body weight or total fat but decreased the visceral/sub-cutaneous adipose tissue ratio by 16% and decreased the leptin/adiponectin (L/A) ratio from 3.63 × 10(-3) to 0.76 × 10(-3). This was associated with a 20% increase in hepatic insulin sensitivity without changes in muscle insulin sensitivity, a 12% increase in HDL cholesterol and a 50% decrease in CRP.

Conclusions/limitations: Pioglitazone significantly changes the visceral-subcutaneous fat distribution and plasma L/A ratio in non diabetic subjects on maintenance dialysis. This was associated with improved hepatic insulin sensitivity and a reduction of cardio-metabolic risk markers. Whether these effects may improve the outcome of non diabetic end-stage renal disease subjects on maintenance dialysis still needs further evaluation.

Trial registration: ClinicalTrial.gov NCT01253928.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of the double…
Figure 1. Flow chart of the double blinded cross-over study.
Figure 2. Individual changes in the leptin/adiponectin…
Figure 2. Individual changes in the leptin/adiponectin ratio.
Figure 3. Glucose metabolism during a 2-step…
Figure 3. Glucose metabolism during a 2-step HEGC, values at baseline and during insulin infusion rates of 0.03 mU/kg/min and 1 mU/kg/min.
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Source: PubMed

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