Conditions: Chronic Kidney Disease
Keywords: Kidney Failure, Chronic Renal Insufficiency, Chronic Proteinuria Albuminuria
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 36
Healthy volunteers: no

Brief summary:
The hypothesis of the current proposal is that chronic pioglitazone therapy will result in improved endothelial function, decreased inflammation, and preservation of renal function in patients with CKD but without diabetes.

Detailed description:
Despite continued improvements in the outcomes of patients with cardiovascular disease, similar improvements have not been seen in patients with chronic kidney disease (CKD). CKD constitutes one of the highest risk populations for cardiovascular disease. When the creatinine clearance is ≤ 60 ml/min the risk for cardiovascular events is greater than that of diabetes. However, few studies have focused on the prevention or treatment of coronary artery disease (CAD) in CKD patients.

The development of endothelial dysfunction and increased inflammation appear to be critical in the development of atherosclerosis and cardiovascular disease. The broad long-term objective of this grant proposal is to determine unique therapies to reduce endothelial dysfunction and inflammation, and thereby help to prevent cardiovascular disease and preserve renal function in patients with CKD. Thiazolidinediones such as pioglitazone appear to improve endothelial function and decrease inflammation, an effect that may be present in patients with or without diabetes.

To address this hypothesis the following Specific Aims are proposed:

1. To determine the effects of chronic pioglitazone therapy on endothelial function in non-diabetic patients with CKD (creatinine clearance ≤ 60 ml/ min, but not on dialysis)
2. To determine the effects chronic pioglitazone therapy on inflammation and oxidative stress in non-diabetic patients with CKD
3. To determine the effects chronic pioglitazone therapy on progression of renal disease in non-diabetic patients with CKD

Arms:
arm 1: Placebo 30 mg daily for 6 months, nitroglycerin was given to check the brachial reactivity. arm 2: Pioglitazone 30 mg daily for 6 months, nitroglycerin was given to check the brachial reactivity.

Interventions: intervention 1: Pioglitazone intervention 2: Placebo intervention 3: Nitroglycerin
Intervention descriptions: intervention 1: Pioglitazone 30 mg daily for 6 months intervention 2: Placebo 30 mg daily for 6 months intervention 3: 0.4 mg sublingual nitroglycerin tablet was given to all patients without a contraindication to check the brachial reactivity.

Protocol document: