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Kidney Week

Abstract: PO0755

Association of Fibrate Use with Cardiovascular Disease Mortality Across CKD Stages

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Rizk, John G., Arizona State University Edson College of Nursing and Health Innovation, Phoenix, Arizona, United States
  • Soohoo, Melissa, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hashemi, Leila, University of California Los Angeles, Los Angeles, California, United States
  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Elevated serum lipids are risk factors for cardiovascular disease (CVD) in the general population and common first-line treatment includes fenofibrates for those with high triglycerides (TG) or low high-density lipoproteins (HDL). Recent studies have suggested that fibrates may be beneficial for CVD death outcomes in those with chronic kidney disease (CKD). Yet how the relationship between fibrates and early CVD death differs across CKD stages remains uncertain.

Methods

In male Veterans with adverse lipid levels ( TG≥150 mg/dL or HDL ≤40 mg/dL), initial fibrate users and non-users were matched on CKD stage, TG and HDL levels. The cohort of 233,082 patients were followed until 2014. We used inverse probability weighting in the fitting of marginal structural models to adjust for time-varying confounding and informative censoring in investigating the average direct effect of fibrate use (reference: non-use), with 24-month cardiovascular mortality. Models were stratified by CKD stage at baseline.

Results

Patients were a mean±SD age of 62±12 years, and 26% of patients had CKD or end-stage renal disease (ESRD). The median[IQR] of baseline TG and HDL were 310 [220,436], and 34 [30, 40] mg/dL, respectively. Across all baseline CKD stages, the use of fibrates were associated with lower risks of 24-month CVD mortality, compared with non-users. These associations gradually declined across advancing CKD stages, where patients with ESRD on renal replacement therapy had the lowest observed risks (Hazard Ratio[95%CI]: 0.54[0.34, 0.87]) [Figure 1].

Conclusion

Fibrate use was associated with lower CVD mortality. These risks varied across CKD stage, but those with ESRD tended to have better CVD death outcomes. Additional studies are imperative to better tailor lipid therapy and management against adverse outcomes among the late-stage CKD and ESRD patients.

Funding

  • Veterans Affairs Support