Fluid
Retention Reversible In Diabetics Treated With
TZD’s
Thiazolidinedione-induced fluid retention in diabetics
with chronic systolic heart failure (HF) is likely
to be peripheral and reversible after drug withdrawal
The mechanism for retention is undefined, however,
say W. H. Tang and colleagues at the Department of
Cardiovascular Medicine, Cleveland, Ohio.
In this
study of 111 patients treated with thiazolidinedione
(TZD), the researchers found no direct link between
the baseline degree of severity of HF and the risk
of fluid retention, the characteristics of which
they sought to define. They point out the association
between TZD and fluid retention is often ascribed
to exacerbation of HF leading to the "proscription
of these potentially useful agents in patients with
chronic HF."
A retrospective chart review was carried out to
find the incidence of fluid retention in this group
of consecutive patients, who were treated from January
1999 to June 2001.
Comparisons of physical signs of retention were
made between the TSD subjects and a diabetic control
group of non-TZD users with chronic HF and fluid
retention who were matched for age and gender. TZD
users with and without fluid retention were also
compared using baseline clinical and echocardiographic
data.
Fluid retention was found to develop in 19 TSD users,
17.1%. This presented predominantly as peripheral
and not central oedema and was seen to reverse after
drug withdrawal.
A comparison of subjects in the upper and lower
tertiles of weight gain found TZD-related fluid retention
developed more in female patients and insulin users.
No
differences were seen, however, in the echocardiographic
severity of cardiac dysfunction or the baseline New
York Heart Association functional class. J Am Coll
Cardiol 2003 Apr 16;41:8:1394-8
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