This is a double-blind randomised placebo-controlled clinical multicenter trial in non-diabetic patients with stage 4 and 5 chronic kidney disease. Eligible patients in the outpatient kidney clinic and patients at the dialysis department will be informed by their treating physician about the study and they will be asked to join the study. Following informed consent the eligible patients will undergo baseline evaluation and will then be followed for a period of 48 weeks. Patients will be randomly divided in two groups: one group will take pioglitazone (30 mg once daily)and the other group will get placebo. The original medication will be continued. The total follow-up will be 48 weeks.

At the start of the study and at 3,6,12,18,24 and 48 weeks during follow-upinflammatory parameters (CRP, hs CRP, IL-6, fetuin,fibrinogen, serum amyloid A), lipid profile, glucose and insulin will be measured. Intima media thickness, pulse wave velocity, subjective global assessment will be performed at 0,24 and 48 weeks.

Inclusion Criteria:

- written consent over 18 years of age stage 4 or 5 chronic kidney disease according the K/DOQI guidelines

Exclusion Criteria:

• life span of less than one year alcohol abuse transaminases > 2.5 times the upper limit diabetes mellitus pregnancy cardiac disease with marked limitation of functional capacity (NYHA III or IV)