The Association of Fibrate Use with Kidney Outcomes and Mortality

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. Additionally, there is limited research on certain kidney outcomes and mixed results of past studies. The aim of this study is to examine the association of fibrate use with incident chronic kidney disease (CKD), end-stage kidney disease (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 Veterans Administration (VA) research database. Associations were examined in Cox proportional hazard models and Fine-Gray model adjusted for demographics, major comorbidities, laboratory measurements, including baseline estimated glomerular filtration rate (eGFR), albuminuria, and medications. Results: We identified 58,773 incident new fibrate users. The overall mean (standard deviation [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 non-use) was associated with a lower risk of death (Hazard ratio [HR]: 0.91, 95% confidential interval [CI]: 0.89-0.93) and ESKD (0.80, 0.71-0.92) but with a higher risk of incident CKD (1.21, 1.19-1.24). 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.