Relationship between urinary sodium excretion and pioglitazone-induced edema

Akinobu Nakamura, Takeshi Osonoi, Yasuo Terauchi, Akinobu Nakamura, Takeshi Osonoi, Yasuo Terauchi

Abstract

To investigate the factors contributing to pioglitazone-induced edema, we analyzed sodium excretion and several clinical parameters before and after administration of pioglitazone. We analyzed these parameters before and after 8 weeks of administration of pioglitazone to female subjects with type 2 diabetes. When we evaluated whether a significant correlation was found between salt excretion and blood pressure, six patients showed such correlation and 20 patients did not. After 8 weeks of pioglitazone administration, five patients had developed edema, and, surprisingly, such correlation was not found in all five subjects. Salt excretion after administration of pioglitazone was significantly lower in subjects who developed edema and those who showed the correlation, and the hematocrit was significantly lower after administration in the subjects who showed the correlation, but not in the edema group. Pioglitazone-induced edema would be caused not only by fluid retention, but also by other factors, such as vascular permeability. (J Diabetes Invest, doi: 10.1111/ j.2040-1124.2010.00046.x, 2010).

Keywords: Edema; Pioglitazone.

Figures

Figure 1
Figure 1
Changes in (a) salt excretion and (b) hematocrit after administration of pioglitazone to three groups for 8 weeks: a group that had no correlation between salt excretion and blood pressure but had edema (group A: open diamonds), a group that had correlation but did not have edema (group B: filled triangles), and a group that had neither correlation nor edema (group C: filled diamonds). Bars indicate the mean of each group.
Figure 2
Figure 2
Hypothesis on mechanisms of pioglitazone‐induced edema. Administration of pioglitazone to the subjects who developed pioglitazone‐induced edema (group A) caused fluid retention because of sodium reabsorption and increased fluid in the intravascular space would be mobilized to extravascular space because of vascular hyperpermeability. In contrast, administration of pioglitazone caused fluid retention in the subjects that had a correlation between salt excretion and blood pressure (group B); however, increased fluid would be retained in the intravascular space. Administration of pioglitazone to the subjects that had neither correlation nor edema (group C) did not cause fluid retention.

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Source: PubMed

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