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Kidney Week

Abstract: PO0556

Fibrates and CKD Patients: A Controversial Issue

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Baki, Aber Halim, Ain Shams University Faculty of Medicine, Cairo, Egypt
  • Zarif, John, Ain Shams University Faculty of Medicine, Cairo, Egypt
Background

Fenofibrates were not previously known to affect renal function tests until some reports indicated that these drugs may lead to a decrease in renal function. Likewise, the nephrotoxic effect of fibrates remains to be vague and unclear.Fenofibrate’s safety in patients with renal insufficiency is an issue because it may increase plasma creatinine. Furthermore, guidelines regarding fenofibrate dosing in renal impairment vary internationally. We investigated fenofibrates’ effects on cardiovascular and on advanced CKD, according to eGFR. The multiple incidents of elevated kidney function tests for patients on fibrates have led us to make this study to review our experience as well as literature on this matter.

Methods

A prospective cohort study over 6 months with a total of 80 patients on fibrates divided into 2 groups, 40 of which received statins and the other 40 continued on fibrates. All our patients were subjected to full history, clinical examination and complete baseline labs.
The kidney function tests including serum creatinine and eGFR were measured at 0,1 , 2 and 6 months’ intervals and lipid profile at 0,3,6 months serially in both groups.

Results

Out of the baseline values of the kidney function tests that were recorded on previous fibrate therapy, the statin group (n=40) showed a significant decrease in all kidney function values including serum creatinine by (0.9mg/dL P=0.001) and an increase in eGFR (8.9 mL/min/1.73 m2, P<0.001). Whilst in the other 40 patients who continued to receive fibrates the kidney function tests continued to rise as serum creatinine showed a significant increase in their mean serum Cr levels (by 0.9 mg/dL or 20%, P=0.001), and a significant decrease in their mean eGFR values (by 8.2 mL/min/1.73 m2 or 20.55%, P<0.001).On the other hand total and LDL Cholesterol were significantly lower in Statin group at all follow up intervals. Also triglycerides were significantly higher in Statin group at the end of month-6 from baseline.

Conclusion

In our study fibrates administration showed a short term state of renal insufficiency. The long term effects of fibrates versus variable renal derangement are yet to be identified. As to lipid profile, shifting from fibrates to statins led to a stastically significant rise in triglycerides but it's clinical impact is yet to be investigated, so established guidelines might need a revision regarding clinical benefits of fibrates versus it's renal injury.