Fibrates in Chronic Kidney Disease Patients: A Controversial Issue

Abstract

Background: Fenofibrates were not previously known to affect renal function tests until some reports indicated that these drugs may lead to a decrease in renal function. Likewise, the nephrotoxic effect of fibrates remains to be vague and unclear. Guidelines regarding fenofibrate dosing in renal impairment vary internationally. Patients and methods: A prospective cohort study over 6 months with a total of 80 patients on fibrates divided into 2 groups, 40 of which received statins, and the other 40 continued on fibrates. All patients were subjected to full history, clinical examination, and complete baseline labs. The KFTs including serum creatinine and eGFR were measured at 0, 1, 2, and 6-months intervals and lipid profile at 0,3,6 months serially in both groups. Results: Out of the baseline values of KFTs, the statin group showed a significant decrease in all kidney function values including mean serum creatinine by (0.9mg/dL, P=0.001) and an increase in eGFR (8.9 mL/min/1.73 m2, P<0.001). Whilst in patients who continued to receive fibrates the KFTs continued to rise as serum creatinine showed a significant increase in their mean serum Cr levels (by 0.9 mg/dL or 20%, P=0.001), and a significant decrease in their mean eGFR values (by 8.2 mL/min/1.73 m2 or 20.55%, P<0.001). On the other hand, total and LDL Cholesterol were significantly lower in the statin group at all follow-up intervals. Also, triglycerides were significantly higher in the Statin group at the end of month-6 from baseline. Conclusion: In our study fibrates administration showed a short-term state of renal insufficiency. The long-term effects of fibrates versus variable renal derangement are yet to be identified.