Rhabdomyolysis due to fenofibrate in 2 patients receiving peritoneal dialysis

Abstract

Two female patients receiving peritoneal dialysis aged 52 (case 1) and 57 (case 2) were treated with fenofibrate 200 mg once daily for increasing serum triacylglycerol. They experienced muscular soreness and weakness in lower limbs and back on 6 and 8 days after taking fenofibrate, respectively. The case 2 also had reduced urine volume. Laboratory tests showed the following values in case 1: serum aspartate aminotransferase (AST) 154 U/L, creatine kinase (CK) 1 862 U/L, creatine kinase isoenzyme (CK-MB) 67 U/L, lactate dehydrogenase (LDH)1 074 U/L, urea nitrogen 14.5 mmol/L, creatinine 926 μmol/L, glomerular filtration rate (GRF) 5.4 ml·min-1·1.73 m-2, and myoglobin >1 000 μg/L. Laboratory tests showed the following values in case 2: AST 150 U/L, CK 10 070 U/L, CK-MB 171 U/L, LDH 399 U/L, urea nitrogen 12.9 mmol/L, creatinine 881 μmol/L, GFR 4.3 ml·min-1·1.73 m-2, and myoglobin >1 000 μg/L.The patients were diagnosed as rhabdomyolysis due to fenofibrate. The symptoms of muscle aches and fatigue in the 2 patients disappeared on day 5 and 3 after fenofibrate withdrawal, respectively. Laboratory tests showed the following values 12 days after drug withdrawal in case 1: AST 35 U/L, CK 68 U/L, CK-MB 23 U/L, LDH 626 U/L, usea nitrogen 10.6 mmol/L, creatinine 725 μmol/L. Laboratory tests showed the following values 7 days after drug withdrawal in case 2: AST 37 U/L, CK 219 U/L, CK-MB 18 U/L, LDH 356 U/L, urea nitrogen 12.5 mmol/L and creatinine 852 μmol/L. Her urine volume returned to the level recorded before medication. Key words: Fenofibrate; Rhabdomyolysis