The effect of oral pioglitazone on muscle protein breakdown in peritoneal dialysis patients: a randomized controlled trial
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Abstract
Background: Insulin resistance which occurs common in patients on chronic continuous ambulatory peritoneal dialysis (CAPD) plays an important role in decreasing available glucose and protein for muscle anabolism. Thiazolidinediones is a PPAR receptor agonist with a high ability to increase insulin sensitivity and possibly their anabolic effects on improve sarcopenia.
Methods: A randomized, placebo-controlled trial, 31 CAPD patients were randomly allocated into two groups: pioglitazone (15 mg/day) and placebo for 16 weeks. Sarcopenia biomarkers include serum myostatin level and body composition by dual-energy X-ray absorptiometry (DXA) were determined before and after the intervention.
Results: At baseline, serum myostatin level was 6.40±3.14 ng/mL in pioglitazone group and 5.12±3.53 ng/mL in placebo group and relative skeletal muscle index was 7.14±1.18 kg/m2 in pioglitazone group and 6.52±1.33 kg/m2 in placebo group. Serum myostatin level significantly decreased in the pioglitazone group compared to the placebo group at 8 weeks (-1.32 (95%CI -1.98 to -0.66) vs. 0.56 (95%CI -0.48 to 1.61) ng/mL; P=0.003) and at 16 weeks (-2.32 (95% CI -3.11 to -1.53) vs. 0.10 (95% CI -0.71 to 0.92) ng/mL; P<0.001). However, relative skeletal muscle index, fat mass and body weight did not change significantly in the both groups. No significant changes were observed in blood pressure, fasting plasma glucose, hemoglobinA1C, and serum creatinine concentrations compared with baseline in either group. No serious side-effects including hypoglycemia and heart failure was detected.
Conclusion: The study indicates that 16-weeks of pioglitazone treatment reduced the serum sarcopenia biomarkers but showed no effect on the muscle mass in no diabetic CAPD patients.
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