Abstract: PO2375
The Effect of Fibrates on Kidney Function and CKD Progression: A Systematic Review and Meta-Analysis of Randomised Studies
Session Information
- CKD: Insights from Recent Clinical Trials and Large Real-World Effectiveness Studies
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Hadjivasilis, Alexandros, Technologiko Panepistemio Kyprou, Limassol, Limassol, Cyprus
- Kousios, Andreas, Hammersmith Hospital, London, London, United Kingdom
- Kouis, Panayiotis, Technologiko Panepistemio Kyprou, Limassol, Limassol, Cyprus
- Panayiotou, Andrie G., Technologiko Panepistemio Kyprou, Limassol, Limassol, Cyprus
Background
Fibrates have proven efficacy in cardiovascular risk reduction and are commonly used, in addition to statins, to control hypertriglyceridemia. Their use is often limited due to reduction in glomerular filtration rate at treatment initiation. However, recent studies suggest benign change in kidney function and improvement of proteinuria; an established early marker of microvascular disease and kidney disease progression. We summarize the evidence from existing trials and provide summary effects of fibrates, alone or in combination, on kidney disease progression and proteinuria.
Methods
Systematic review and Meta-analysis of randomised controlled trials(PROSPERO CRD42020187764).
Results
Out of 12243 potentially eligible studies, 29 were included in qualitative and quantitative analysis, with a total of 20176 patients. Mean creatinine increased by 1.05 [95% CI(0.63 to 1.46)] units in patients receiving fibrates vs comparator, and this was similar in all other subgroups. eGFR showed a bigger decrease in the fibrates arm [SMD -1.99; 95% CI(-3.49 to -0.48)] when all studies were pooled together. Notably, short-term serum creatinine and eGFR changes remained constant in the long-term. Pool estimates show that fibrates improve albuminuria progression, RR 0.86; 95% CI(0.76 to 0.98); albuminuria regression, RR 1.19; 95% CI (1.08 to 1.310)]. Two studies showed reduction in progression to ESKD, albeit without statistical significance.
Conclusion
Fibrates improve albuminuria in patients with and without diabetes when used to treat hyperlipidaemia. The modest creatinine increase should not be a limiting factor for fibrate initiation in people with preserved renal function or mild CKD. The long-term effects on kidney disease progression warrant further study.