Kidney Week

Abstract: TH-PO1097

Comparative Association of De Novo Lipid-Lowering Therapy Initiation with Kidney Outcomes 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

Mohammad Abdullah Al Zubair Naim

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas, PhD

• Streja, Elani, University of California Irvine, Irvine, California, United States

Elani Streja, PhD, MPH

• Davis, Robert L., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Robert L. Davis

• Kalantar-Zadeh, Kamyar, VA Long Beach Healthcare System, Long Beach, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

The effect of lipid-lowering therapies (LLTs) on renal outcomes in patients with chronic kidney disease (CKD) is understudied. We conducted a pharmacoepidemiologic study to compare the extent of decline in kidney function and the risk of end-stage kidney disease (ESKD) in non-dialysis-dependent incident CKD patients initiating de-novo niacin and fibrate monotherapy vs. statin monotherapy.

Methods

We leveraged data from a nationwide historical cohort of 3,562,882 US Veterans with normal kidney function enrolled between October 2004 and September 2006. Using longitudinal evaluation of eGFR and albuminuria, we defined a non-dialysis-dependent incident CKD cohort (n= 247,270) at risk of de-novo LLT exposure. We then identified new users of statins (n=46,526), fibrates (n=2,417), and niacin (n=1,524) and followed up these patients through December 31, 2018. We compared the slopes of eGFR in fibrate and niacin users to those of statin users in mixed-effects models adjusted for baseline characteristics. Using Cox proportional hazards models, we then compared the risk of ESKD (defined as initiation of kidney replacement therapy) of fibrate and niacin initiators to that of statin initiators, adjusted for baseline characteristics.

Results

Compared to statins, fibrate use was associated with a significantly lower intraindividual eGFR decline (difference in eGFR slope: 0.35 mL/min/1.73m²/year [95% CI: 0.14, 0.55], p=0.001) and a lower risk of ESKD (hazard ratio: 0.76 [95% CI: 0.59, 0.97], p= 0.026). Niacin use was not associated with significantly different kidney outcomes compared to statin use (difference in eGFR slope: 0.17 mL/min/1.73m²/year [-0.08, 0.41], p=0.19; risk of ESKD (hazard ratio: 1.04 [0.77, 1.39], p= 0.81) (Figure).

Conclusion

In patients with non-dialysis-dependent CKD, fibrate therapy (compared to statins) was associated with better kidney outcomes. The comparative benefit of fibrates vs. statins in this population should be tested in clinical trials.

Funding

• Veterans Affairs Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025j60ptwgz