Fenofibrate Use Associated with Lower Rates of CKD Incidence and Progression

Austin—In patients with type 2 diabetes, abnormalities in lipid metabolism may contribute to the development and progression of chronic kidney disease (CKD). Results from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial  demonstrated that fenofibrate induced early and reversible reduction in kidney function. Rebecca Frazier, MD, and colleagues conducted a post-hoc analysis of data from the ACCORD trial to test the hypothesis that there would be an association between the use of fenofibrate compared with placebo and beneficial long-term effects on renal outcomes in ACCORD participants.

The researchers reported results of the analysis during  a poster session at the NKH 2018 Spring Clinical Meetings in a poster titled Fenofibrate Use and Incidence and Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes.

Outcomes of interest were the association of fenofibrate use with change in estimated glomerular filtration rate (eGFR) and with time-to-development of microalbuminuria, macroalbuminuria, CKD, and renal failure. Serum creatinine was measured every 4 months; albuminuria was assessed yearly. To avoid early changes in eGFR related to fenofibrate exposure, 4-month eGFR was used as the initial eGFR measurement, and month 4 as the start of follow-up time.

The analysis included data on 2636 participants in the fenofibrate arm and 2632 participants in the placebo arm. Median follow-up was 4 years. During the follow-up period, there was an association between use of fenofibrate and a lower rate of eGFR decline (–0.39 mL/min/1.73 m2/year in the fenofibrate group vs –1.55 mL/min/1.73 m2/year in the placebo group; P<.01) and with lower incidence of microalbuminuria (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87), macroalbuminuria (HR, 0.73; 95% CI, 0.58-0.92) and CKD (HR, 0.79; 95% CI, 0.63-0.99). There was no difference between the two groups in development of renal failure.

In conclusion, the researchers said, “Compared to placebo, fenofibrate use was associated with lower rates of incident CKD and progression of CKD in ACCORD. Fibrates may help reduce the incidence and severity of CKD in the diabetic population.”

Source: Frazier R, Mehta R, Cai X, et al. Fenofibrate use and incidence of chronic kidney disease in patients with type 2 diabetes. Abstract of a poster presented at the National Kidney Foundation 2018 Spring Clinical Meetings, April 10-14, 2018, Austin, Texas.