The Influence of Rosiglitazone on the Diuretic Effect of Furosemide and Amiloride - Full Text View

Purpose

Thiazolidinedionederivates (TZD’s) are Peroxisome-Proliferator-Activated-Receptor-γ agonists (PPARγ-agonists) and enhance insulin sensitivity. One of the side effects, however, is the fact that subjects treated with these drugs seem to be more prone to fluid retention. The precise mechanism of rosiglitazone-related fluid retention is unknown, but it is clear that either primary or secondary renal sodium retention is part of the mechanism. Furthermore in observational studies, TZD-related oedema seems to be resistant to loop diuretic therapy. The recent finding that rosiglitazone induces upregulation of the epithelial sodium channel (ENaC) in the kidney could be the explanation for TZD-related fluid retention and the observed resistance to loop diuretics. In the present human in-vivo study the following hypothesis will be tested:

Rosiglitazone treatment stimulates the activity of ENaC in the distal nephron, which enhances the natriuretic effect of amiloride and decreases the natriuretic effect of furosemide in parallel.

Condition	Intervention
Insulin Resistance	Drug: Rosiglitazone versus placebo Drug: response (sodium excretion) to amiloride infusion Drug: response (sodium excretion) to furosemide infusion

ChemIDplus related topics:

Rosiglitazone Rosiglitazone Maleate Amiloride Furosemide

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double-Blind, Placebo Control, Crossover Assignment, Pharmacokinetics/Dynamics Study

Official Title:	The Influence of Rosiglitazone on the Diuretic Effect of Furosemide and Amiloride. A Double-Blind Placebo Controlled Cross Over Study.

Further study details as provided by Radboud University:

Primary Outcome Measures:

Difference in cumulative sodium excretion over an 8-hour period following amiloride infusion after 9 weeks of treatment with either rosiglitazone or placebo.

Secondary Outcome Measures:

The difference in ER50 (urine excretion rate of furosemide with the half maximal effect) after 8 weeks of treatment with either rosiglitazone or placebo.
The difference in the amount of ENac and Na-K-Cl transporter in the urine measured after 8 weeks of treatment with either rosiglitazone or placebo

Estimated Enrollment:	12
Study Start Date:	February 2006
Estimated Study Completion Date:	November 2006

Eligibility

Ages Eligible for Study:	30 Years to 70 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Healthy but with 2 features of the metabolic syndrome (AHA/NHLBI) (16)
Willing and able to provide a signed and dated written informed consent.
Male or female subject aged between 30 and 70 years

Exclusion Criteria:

Fasting glucose > 7,0 mmol/L or the use of hypoglycaemic agents. If fasting plasma glucose is between 6.1 and 7,0 mmol/L,an oral 75 g glucose test will be performed to exclude diabetes mellitus.
Exposure to a PPAR-g agonist during the last 4 months or a documented significant hypersensitivity to a PPAR-g agonist.
Participant in another study.
Angina or heart failure (NYHA I-IV).
Clinically significant liver disease (3 times the upper normal limit of ALAT, ASAT, AF, γGT or LDH)
Clinically significant anaemia (male Hb < 6,9 mmol/L, female < 6,25 mmol/L)
Creatinin clearance < 40 mL/min
Pregnancy, lactation
Alcohol or drug abuse. Liquorice

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00285805

Locations


Netherlands
	Radboud University Nijmegen medical centre
	Nijmegen, Netherlands, 6500 HB

Sponsors and Collaborators

Radboud University

Investigators


Principal Investigator:	Paul Smits, MD, PhD	Radboud University Nijmegen Medical Centre, head of department Pharmacology and Toxicology.

Principal Investigator:	Cees JJ Tack, MD, PhD	Radboud University Nijmegen Medical Centre, chairman of the departement of diabetology

More Information

Publications:

Nesto RW, Bell D, Bonow RO, Fonseca V, Grundy SM, Horton ES, Le Winter M, Porte D, Semenkovich CF, Smith S, Young LH, Kahn R; American Heart Association; American Diabetes Association. Thiazolidinedione use, fluid retention, and congestive heart failure: a consensus statement from the American Heart Association and American Diabetes Association. October 7, 2003. Circulation. 2003 Dec 9;108(23):2941-8. Review. No abstract available.

Hong G, Lockhart A, Davis B, Rahmoune H, Baker S, Ye L, Thompson P, Shou Y, O'Shaughnessy K, Ronco P, Brown J. PPARgamma activation enhances cell surface ENaCalpha via up-regulation of SGK1 in human collecting duct cells. FASEB J. 2003 Oct;17(13):1966-8. Epub 2003 Aug 15.

Guan Y, Hao C, Cha DR, Rao R, Lu W, Kohan DE, Magnuson MA, Redha R, Zhang Y, Breyer MD. Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med. 2005 Aug;11(8):861-6. Epub 2005 Jul 10.

Niemeyer NV, Janney LM. Thiazolidinedione-induced edema. Pharmacotherapy. 2002 Jul;22(7):924-9. Review.

van Meyel JJ, Smits P, Russel FG, Gerlag PG, Tan Y, Gribnau FW. Diuretic efficiency of furosemide during continuous administration versus bolus injection in healthy volunteers. Clin Pharmacol Ther. 1992 Apr;51(4):440-4.

Baba WI, Lant AF, Smith AJ, Townshend MM, Wilson GM. Pharmacological effects in animals and normal human subjects of the diuretic amiloride hydrochloride (MK-870). Clin Pharmacol Ther. 1968 May-Jun;9(3):318-27. No abstract available.

Study ID Numbers:	AR-49653-3
First Received:	February 1, 2006
Last Updated:	September 14, 2006
ClinicalTrials.gov Identifier:	NCT00285805
Health Authority:	Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)

Keywords provided by Radboud University:

Rosiglitazone

Furosemide

Amiloride

Epithelial sodium channel

Sodium excretion

Study placed in the following topic categories:

Hyperinsulinism

Metabolic Diseases

Amiloride

Insulin Resistance

Metabolic disorder

Glucose Metabolism Disorders

Furosemide

Rosiglitazone

Additional relevant MeSH terms:

Membrane Transport Modulators

Hypoglycemic Agents

Molecular Mechanisms of Pharmacological Action

Natriuretic Agents

Therapeutic Uses

Physiological Effects of Drugs

Diuretics

Sodium Channel Blockers

Cardiovascular Agents

Sodium Potassium Chloride Symporter Inhibitors

Pharmacologic Actions

ClinicalTrials.gov processed this record on September 04, 2008

Sponsored by:	Radboud University
Information provided by:	Radboud University
ClinicalTrials.gov Identifier:	NCT00285805