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Abstract: FR-PO412

Fibrate Therapy in Hemodialysis Patients: A Prospective 10-Year Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kurathong, Sathit, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
  • Pongsittisak, Wanjak, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
  • Trakarnvanich, Thananda, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background

KDIGO guideline suggests that statin should not be initiated in hemodialysis (HD) patients. Fibric acid derivative (fibrate) is another lipid-lowering drug class capable of reducing plasma triglyceride (TG), cholesterol and LDL-cholesterol (LDL-C), but has been rarely used in HD patients due to potential adverse events, namely myositis and transaminitis. Recent study demonstrated that low-dose fenofibrate (100 mg) was safe in HD patients. The efficacy of low-dose fenofibrate (LF) and gemfibrozil (G), two most commonly-used fibrates, has not been compared before in patients with advanced CKD. This research aims to study the lipid-lowering effect and safety profiles of LF and G in HD patients with hyperlipidemia.

Methods

This was a prospective study of all HD patients with hyperlipidemia who were initiated on fixed-dose fibrates at Vajira Hospital between January 2009 and December 2018. The data collected were baseline characteristics, kidney function, body mass index and type of fibrate. All patients were followed for 6 months. Changes in fasting lipid profiles were recorded and compared at 3 and 6 months after initiating treatment. Liver function tests and muscle enzyme were monitored at the beginning and two months after starting drug.

Results

There were overall 94 HD patients recruited to receive fibrate therapy (33 LF and 61 G) without additional lipid lowering drug. At 6 month, LF 100 mg effectively lowered both fasting TG and LDL-C (-34% and -21%; p=0.004 and 0.01 respectively) whereas G 600 mg significantly reduced fasting TG (-29%, p=0.003) but not LDL-C level (-11%; p=0.06). Myalgia and myositis were reported in 5 patients (13.7%) in LF group and 6 patients (11.3%) in G groups. No patient experienced rhabdomyolysis or severe myositis requiring discontinuation of fibrate. Transaminitis occurred in 5 patients from each LF and G group (15.2% and 8.2% respectively). Only 1 patient receiving LF had significant transaminitis (ALT>3 x upper limit of normal) that required fenofibrate discontinuation. Three patients died (2 in F group and 1 in G group) from causes determined not to be fibrate-related.

Conclusion

Both low-dose fenofibrate and gemfibrozil were effective in lowering plasma TG but only fenofibrate could significantly reduce LDL-C in HD patients. Both drugs were well-tolerated and could be useful alternatives to statin in HD patients with hyperlipidemia.

Funding

  • Government Support - Non-U.S.