A randomized controlled pilot trial of anakinra and pioglitazone for protein metabolism in patients on maintenance haemodialysis

Abstract

Abstract Background Chronic inflammation and insulin resistance are highly prevalent in patients on maintenance haemodialysis (MHD) and are strongly associated with protein energy wasting. We conducted a pilot, randomized, placebo‐controlled trial of recombinant human interleukin‐1 receptor antagonist (IL‐1ra) and pioglitazone to explore the safety, feasibility and efficacy for insulin‐mediated protein metabolism in patients undergoing MHD. Methods Twenty‐four patients were randomized to receive IL‐1ra, pioglitazone or placebo for 12 weeks. Changes in serum inflammatory markers and insulin‐mediated protein synthesis, breakdown and net balance in the whole‐body and skeletal muscle compartments were assessed using hyperinsulinaemic–hyperaminoacidemic clamp technique at baseline and Week 12. Results Among 24 patients, median (interquartile range) age was 51 (40, 61), 79% were African American and 21% had diabetes mellitus. All patients initiated on intervention completed the study, and no serious adverse events were observed. There was a statistically significant decrease in serum high‐sensitivity C‐reactive protein in the pioglitazone group compared with placebo, but not in the IL‐1ra group. No significant differences in the changes of whole‐body or skeletal muscle protein synthesis, breakdown and net balance were found between the groups. Conclusions In this pilot study, there were no statistically significant effects of 12 weeks of IL‐1ra or pioglitazone on protein metabolism in patients on MHD. Clinicaltrials.gov registration: NCT02278562.

Keywords

• inflammation
• insulin resistance
• maintenance haemodialysis
• protein metabolism