Abstract: TH-PO1096
Comparative Effectiveness of Different Lipid-Lowering Medications in Increasing HDL-Cholesterol Levels in Patients with Nondialysis-Dependent CKD
Session Information
- CKD: Therapies, Innovations, and Insights
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Naim, Mohammad Abdullah Al Zubair, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, University of California Irvine, Irvine, California, United States
- Davis, Robert L., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, VA Long Beach Healthcare System, Long Beach, California, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Higher HDL cholesterol (HDL-C) is associated with better clinical outcomes in patients with chronic kidney disease (CKD). The comparative effectiveness of various lipid-lowering medications in changing HDL-C in patients with non-dialysis-dependent (NDD) CKD is unclear. We examined the association of niacin and fibrate monotherapy vs. statin monotherapy with increase in HDL-C in NDD-CKD.
Methods
Using a nationwide historical cohort of 3,562,882 US Veterans with eGFR >60 ml/min/1.73m2 between October 2004 and September 2006 and followed up until September 2019, we identified 247,270 incident CKD patients. We defined new users of statins (n=34,744), fibrates (n=1,492), and niacin (n=944) from pharmacy dispensation data. We compared intraindividual slopes of HDL-C (from baseline through 1 year) for new users of fibrates and niacin vs. statin users, using mixed-effect models adjusted for baseline and time-varying covariates. We also compared the likelihood of providing clinically significant (>10%) improvement in HDL-C.
Results
Compared to statin use, the multivariable-adjusted annualized intraindividual elevation of HDL-C was significantly higher following fibrate (1.15 mg/dL/year [95% CI: 0.43, 1.87]; p=0.002) and niacin monotherapy (2.51 mg/dL/year [95% CI: 1.62, 3.41]; p<0.001) (Figure). Both fibrates (odds ratio, OR: 1.65 [95% CI: 1.50, 1.83]; p<0.001) and niacin (OR: 2.42 [95% CI: 2.14, 2.72]; p<0.001) were more likely than statins to provide clinically significant HDL-C elevation (Table).
Conclusion
Fibrates and niacin were associated with a significantly larger increase in HDL-C compared to statins in patients with NDD-CKD. Further studies should explore whether HDL-C elevation affects clinical outcomes.
Clinically significant increase in HDL-C (OR) in different mixed-effects models
| Mixed effects models | Clinically significant elevation in HDL-C Odds ratio (95% CI) | ||
| Fibrate vs statin | Niacin vs statin | ||
| Model 1 | Unadjusted | 1.64 [1.49, 1.82], p<0.001 | 2.58 [2.29, 2.91], p<0.001 |
| Model 2 | Baseline and time-dependent covariates (eGFR, AST, ALT) adjusted | 1.65 [1.50, 1.83], p<0.001 | 2.42 [2.14, 2.72], p<0.001 |
Funding
- Veterans Affairs Support