Kidney Week

Abstract: TH-PO1069

Kidney Safety of Prescribed Oral Fibrates in Veterans without CKD

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | 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

• Takahashi, Rina, The Lundquist Institute, Torrance, California, United States

Rina Takahashi, MD, PhD

• Shen, Jenny I., The Lundquist Institute, Torrance, California, United States

Jenny I. Shen, MD, MS, FASN

• Tran, Diana, The Lundquist Institute, Torrance, California, United States

Diana Tran, MPH

• Elali, Ibrahim, The Lundquist Institute, Torrance, California, United States

Ibrahim Elali, MD

• Dai, Tiane, The Lundquist Institute, Torrance, California, United States

Tiane Dai, MD, PhD

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

Keiichi Sumida, MD, PhD, MPH, FASN

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

Fridtjof Thomas, PhD

• Rhee, Connie, University of California Los Angeles, Los Angeles, California, United States

Connie Rhee, MD, MS

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

Csaba P. Kovesdy, MD, FASN

• Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States

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

Background

Prescribing fibrate medications can result in an acute increase in serum creatinine, making assessing renal outcomes associated with fibrates difficult. There is limited research on certain renal outcomes, and past studies have mixed results. This study aims to examine the association of fibrate use with incident chronic kidney disease (CKD) and incident end-stage renal disease (ESRD) in a large national cohort of veterans of the United States (US) who have long follow-ups.

Methods

A retrospective cohort study examined the association of de novo prescription of fibrate medications during the baseline period with incident CKD and ESRD over 14 years. Patients (n=688,382) were selected from VA databases if they had albuminuria data from 2004 to 2006. Cox proportional hazard models (Model 2-6) and Fine-Gray competitive risk models (Model 7, competing events: ESRD, death) were used and adjusted for demographics, major comorbidities, labs, baseline estimated glomerular filtration rate (eGFR), albuminuria, and medications.

Results

We identified 58,773 incident new fibrate users. The overall mean (SD) age was 59 (13) years, with 6.6% female, 17.9% Black, and 7.0% Hispanic, and baseline triglycerides of 119 (81, 181) mg/dl (users 334 (228, 497), non-users 112 (79, 163)) mg/dl. Fibrate users were more likely to be male, White, current smokers, and had higher frequencies of comorbidities. Fibrate use (vs. non-use) was associated with a higher risk of CKD (Model 6, Hazard ratio (HR): 1.21, 95% confidential interval [CI]: 1.19-1.24) but with a lower risk of ESRD (Model 6, HR: 0.80, 95% CI: 0.71-0.92). Fine-gray models showed similar results (Model 7).

Conclusion

In this large national cohort of US Veterans with long follow-up, fibrate use was associated with a higher risk of incident CKD but a lower risk of ESRD. Further studies are warranted to corroborate the potential benefits of fibrate on kidney function.

Funding

• Veterans Affairs Support