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Kidney Week

Abstract: FR-PO237

Improvement in Kidney Function upon Discontinuation of Fenofibrate in Outpatient Nephrology Consultations for CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Justiniano Magraner, Rafael A., Ochsner Clinic Foundation, Metairie, Louisiana, United States
  • Gonzalez, Manuel E., Ochsner Clinic Foundation, Metairie, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Clinic Foundation, New Orleans, Louisiana, United States
Background


It has been noted in observational and interventional trials that individuals exposed to fenofibrate can exhibit a rise in serum creatinine (sCr) concentration. However, it is not known to what extent this phenomenon impacts kidney function in patients who are referred to a nephrology clinic for consultation for chronic kidney disease (CKD).

Methods


We prospectively collected data in patients referred to a nephrology clinic for new evaluation of a recent rise in sCr or CKD who underwent discontinuation of fenofibrate to assess the effect of that intervention on kidney function, i.e., sCr and estimated glomerular filtration rate (eGFR). Fenofibrate was discontinued when no other cause for a recent rise in sCr or CKD was identified at the time of consultation.

Results

A total of 16 patients (69% women, 75% white, 56% type 2 diabetes, 31% peripheral arterial disease, 19% NASH) were captured over 1.5 years, median baseline sCr 1.9 (1.1 – 2.4) mg/dL and eGFR 34 (22 – 57) ml/min; proteinuria was absent in 13 (81%) patients. At 3 months (n = 16), median sCr decreased to 1.4 (0.9 – 2.2) mg/dL (p < 0.01) and median eGFR increased to 45 (27 – 71) ml/min (p < 0.05). At 6 months (n = 14), median sCr decreased to 1.5 (0.9 – 2.2) mg/dL (p < 0.05) and median eGFR increased to 42 (26 – 71) ml/min (p = 0.08). A ≥ 30% rise in eGFR was observed in 50% of patients at 3 months and it persisted in 46% and 50% of patients at 6 and 12 months, respectively. Median relative change in eGFR was +29% (+7 to +83), +24% (-13 to +68) and +29% (0 to +78) at months 3, 6 and 12, respectively. Triglyceride level increased by > 2-fold in 4 patients during follow up, whereas it remained within the same range in the remaining 12 patients (only 3 required gemfibrozil).

Conclusion

Discontinuation of fenofibrate in patients referred for CKD evaluation can result in sustained improvement in kidney function. There is a need to raise awareness among primary practitioners about this phenomenon that prompts consultations to nephrology. Furthermore, these proof-of-concept pilot data may serve as rationale for a prospective controlled study