Association between rosiglitazone use and decline in renal function in patients with type 2 diabetes mellitus

Background: Use of thiazolidinediones (TZDs) in treatment of type 2 diabetes mellitus (T2DM) has recently become a matter of major controversy regarding their cardiovascular and renal safety. The aim of this study is to investigate the association between rosiglitazone use and renal function in diabetic patients. Methods: This is a retrospective cohort study conducted on a population of patients with T2DM treated at a large public health service organization. All patients who received continuous rosiglitazone therapy for at least 1 year were included in the study group. For each patient in the study group, control patients with T2DM never treated with rosiglitazone were selected from the same population and matched for age, sex, HbA1c% and date of study entry. Level of renal function was expressed as estimated glomerular filtration rate (eGFR), calculated by the simplified Modification of Diet in Renal Disease (MDRD) Study equation. Results: In total, 5,666 patients were included in the study: 1,304 were treated with rosiglitazone, and 4,362 were matched controls. Baseline eGFR was similar in both groups (74.6 +/- 22.9 vs. 73.8 +/- 23.3 ml/min per 1.73 m(2), respectively; p=0.291). After 5 years of follow-up, eGFR was significantly lower in the rosiglitazone-treated group than in control group (67.7 +/- 23.6 vs. 73.8 +/- 25.2 ml/min per 1.73 m(2), p<0.001). Conclusion: The use of rosiglitazone may be associated with a decline of renal function in patients with T2DM. Further studies are needed to better quantify the risk-benefit trade-offs associated with rosiglitazone therapy.