Kidney Week

Abstract: FR-PO0274

Bile Acid Sequestrants and Kidney Outcomes in Patients with CKD

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Naim, Mohammad Abdullah Al Zubair, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Mohammad Abdullah Al Zubair Naim, PhD

• 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, Harbor-UCLA Medical Center, Torrance, 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

Bile acid sequestrants (BAS) are guideline-recommended lipid-lowering therapies (LLT) for dyslipidemia management. These non-systemic bile-acid binders increase the clearance of bile acids and the subsequent conversion of cholesterol to bile acids. Although prescribed to lower low-density lipoprotein (LDL) cholesterol, evidence on renal outcomes of bile acid sequestrant use in patients with chronic kidney disease (CKD) is limited.

Methods

From a nationwide cohort of 3,562,882 US Veterans, we first identified 72,216 patients with incident CKD, among whom 4,328 initiated de novo BAS therapy and 67,888 were LLT non-users. Using multivariable adjusted Cox models in a target trial emulation framework, we compared the associations of BAS use (vs. LLT non-use) with major adverse kidney events [MAKE] (a composite of a sustained ≥57% decrease in eGFR from baseline, sustained eGFR<15 mL/min/1.73 m², incident end-stage kidney disease, and all-cause death) during follow-up of up to 5 years.

Results

Of the 72,216 patients, 22,793 experienced MAKE after a median follow-up of 3.1 years (event rate, 105.2 [95% CI: 103.8, 106.5] per 1000 person years). After adjusting for baseline covariates, de novo BAS use was not significantly associated with MAKE (Hazard Ratio [HR], 1.04 [95% CI, 0.98, 1.10]; p=0.22) (Table).

Conclusion

In this large nationwide cohort of patients with non-dialysis dependent CKD, compared to LLT non-use, de novo BAS use was not significantly associated with MAKE, suggesting no elevated renal risk.

Acknowledgment

This study was supported by grant I01HX002680 to Dr. Kovesdy and is the result of work supported with resources and the use of facilities at the Memphis and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource
Center.

Funding

• Veterans Affairs Support