The Association of Fibrate Use with Kidney Outcomes and Mortality

Key Points In this large national cohort of United States veterans followed over 14 years, fibrate was associated with a higher risk of incident CKD. Fibrate use was also associated with a lower risk of ESKD and all-cause mortality. Considering the potential long-term benefits, clinicians should not necessarily avoid fibrate use, with careful monitoring of kidney function. Background Fibrate use can result in an acute increase in serum creatinine, making assessing kidney outcomes associated with fibrates difficult in studies with short follow-up times. In addition, there is limited research on certain kidney outcomes and mixed results of past studies. The aim of this study was to examine the association of fibrate use with incident CKD, ESKD, and mortality in a large national cohort of United States (US) Veterans. Methods A retrospective cohort study was conducted to examine the association of de novo prescription of fibrate medications with incident CKD, ESKD, and mortality over up to 14 years of follow-up. Patients ( N =688,382) were selected from the national Department of Veterans Affairs (VA) research database. Associations were examined in Cox proportional hazards model and Fine-Gray model adjusted for demographics, major comorbidities, laboratory measurements including baseline eGFR, albuminuria, and medications. Results We identified 58,773 incident new fibrate users. The overall mean (SD) age was 59 (13) years, with 7% female, 18% Black, and 7% Hispanic. Fibrate users were more likely to be male, White, current smokers, and had higher frequencies of comorbidities. In the fully adjusted model, fibrate use (versus nonuse) was associated with a lower risk of death (hazard ratio, 0.91; 95% confidential interval, 0.89 to 0.93) and ESKD (0.80, 0.71 to 0.92) but with a higher risk of incident CKD (1.21, 1.19 to 1.24). Conclusions In this large national cohort of US Veterans with long follow-up time, fibrate use was associated with a higher risk of incident CKD but a lower risk of ESKD and mortality. Further studies are needed to corroborate the potential benefits of fibrate on kidney function and survival.