Issue 154 Item 14 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