TY - JOUR
T1 - Evaluation of the incidence and risk factors for development of fenofibrate-associated nephrotoxicity
AU - Attridge, Rebecca L.
AU - Linn, William D.
AU - Ryan, Laurajo
AU - Koeller, Jim
AU - Frei, Christopher R.
N1 - Funding Information:
CRF is supported by the U.S. National Institutes of Health in the form of a NIH/KL2 career development award (3UL1RR025767).
PY - 2012/1
Y1 - 2012/1
N2 - Background: Fenofibrate-associated nephrotoxicity has been described in two randomized controlled trials and several observational studies. However, little is known regarding its incidence and the population(s) at risk. Objective: This study aims to quantify the incidence and identify potential risk factors for development of nephrotoxicity in patients receiving fenofibrate. Methods: A retrospective, observational study was conducted in the South Texas Veterans Health Care System. Data were collected regarding baseline demographics, concurrent medical conditions, medications, laboratory results, and fenofibrate use. Results: Within 6 months after initiation of fenofibrate in 428 patients, 115 (27%) experienced an increase in serum creatinine of ≥0.3 mg/dL. Any renal disease (P =.001), chronic kidney disease (P =.01), and diabetes (P =.02) were significantly more prevalent in patients with fenofibrate-associated nephrotoxicity. Patients with nephrotoxicity had significantly greater serum creatinine (1.2 [SD 0.3] vs. 1.1 mg/dL [SD 0.3], P =.0002) and lower estimated glomerular filtration rate (72 [SD 20] vs 81 mL/min/1.73m 2 [SD 20], P <.0001) at baseline. These patients also had greater use of calcium channel blockers (P =.0003), furosemide (P =.02), and angiotensin-converting enzyme inhibitors (P =.02). The incidence of nephrotoxicity was significantly greater in patients initiated on high-dose versus those on low-dose fenofibrate (P =.002). In a multivariable regression model, renal disease (P =.02), high-dose fenofibrate (P =.001), and dihydropyridine calcium channel blocker use (P =.02) were determined to be independent predictors of development of increased serum creatinine on fenofibrate. Conclusion: This observational study suggests fenofibrate-associated nephrotoxicity occurs more frequently than previously reported, particularly in patients with renal disease and in those receiving high-dose fenofibrate or concomitant calcium channel blockers.
AB - Background: Fenofibrate-associated nephrotoxicity has been described in two randomized controlled trials and several observational studies. However, little is known regarding its incidence and the population(s) at risk. Objective: This study aims to quantify the incidence and identify potential risk factors for development of nephrotoxicity in patients receiving fenofibrate. Methods: A retrospective, observational study was conducted in the South Texas Veterans Health Care System. Data were collected regarding baseline demographics, concurrent medical conditions, medications, laboratory results, and fenofibrate use. Results: Within 6 months after initiation of fenofibrate in 428 patients, 115 (27%) experienced an increase in serum creatinine of ≥0.3 mg/dL. Any renal disease (P =.001), chronic kidney disease (P =.01), and diabetes (P =.02) were significantly more prevalent in patients with fenofibrate-associated nephrotoxicity. Patients with nephrotoxicity had significantly greater serum creatinine (1.2 [SD 0.3] vs. 1.1 mg/dL [SD 0.3], P =.0002) and lower estimated glomerular filtration rate (72 [SD 20] vs 81 mL/min/1.73m 2 [SD 20], P <.0001) at baseline. These patients also had greater use of calcium channel blockers (P =.0003), furosemide (P =.02), and angiotensin-converting enzyme inhibitors (P =.02). The incidence of nephrotoxicity was significantly greater in patients initiated on high-dose versus those on low-dose fenofibrate (P =.002). In a multivariable regression model, renal disease (P =.02), high-dose fenofibrate (P =.001), and dihydropyridine calcium channel blocker use (P =.02) were determined to be independent predictors of development of increased serum creatinine on fenofibrate. Conclusion: This observational study suggests fenofibrate-associated nephrotoxicity occurs more frequently than previously reported, particularly in patients with renal disease and in those receiving high-dose fenofibrate or concomitant calcium channel blockers.
KW - Fenofibrate
KW - Fenofibrate-associated nephrotoxicity
KW - Fibric aid derivatives
KW - Nephrotoxicity
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U2 - 10.1016/j.jacl.2011.08.008
DO - 10.1016/j.jacl.2011.08.008
M3 - Article
C2 - 22264570
AN - SCOPUS:84856219904
VL - 6
SP - 19
EP - 26
JO - Journal of Clinical Lipidology
JF - Journal of Clinical Lipidology
SN - 1933-2874
IS - 1
ER -