Thiazolidinediones in peritoneal dialysis patients.

摘要

The peroxisome proliferator-activated receptors (PPARs) are a subfamily of the nuclear receptor superfamily and they regulate gene expression in response to ligand binding (1). Various fatty adds serve as the natural ligands for these receptors. The thiazolidinediones are direct gamma-type PPAR (PPARgamma) agonists and representa novel class of compounds for the treatment of type 2 diabetes (1,2). These drugs directly improve insulin resistance and decrease plasma insulin levels. As a result, they may, at least theoretically, decrease the risk of cardiovascular disease in patients with type 2 diabetes. Research on the non glucose-lowering effects of thiazolidinediones has demonstrated several beneficial effects, including a decrease in blood pressure, correction of diabetic dysLipid-emia, improvement of fibrinolysis, and decrease in carotid artery intima media thickness (3). Through PPAR activation, thiazolidinediones may exert some beneficial effects on the kidney; however, it is unknown whether this protective effectis due to a directaction on PPARgamma at the glomerular, tubular, or vascular level (4). More recently, PPARgamma expression was demonstrated in peritoneal me-sothelial cells (5), although the exact role of PPARgamma in peritoneal physiology remains elusive.