George Institute for Global Health, the University of Sydney, Sydney, New South Wales, Australia.
J Am Coll Cardiol. 2012 Nov 13;60(20):2061-71. doi: 10.1016/j.jacc.2012.07.049. Epub 2012 Oct 17.
The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of fibrate therapy in the chronic kidney disease (CKD) population.
Fibrate therapy produces modest cardiovascular benefits in people at elevated cardiovascular risk. There is limited evidence about the clinical benefits and safety of fibrate therapy in the CKD population.
MEDLINE, EMBASE, and the Cochrane Library were systematically searched (1950 to January 2012) for prospective randomized controlled trials assessing the effects of fibrate therapy compared with placebo in people with CKD or on kidney-related outcomes were included.
Ten studies including 16,869 participants were identified. In patients with mild-to-moderate CKD (estimated glomerular filtration rate [eGFR] ≤60 ml/min/1.73 m(2)), fibrates improved lipid profiles (lowered total cholesterol [-0.32 mmol/l, p = 0.05] and triglyceride levels [-0.56 mmol/l, p = 0.03] but not low-density lipoprotein cholesterol [-0.01 mmol/l, p = 0.83]; increased high-density lipoprotein cholesterol [0.06 mmol/l, p = 0.001]). In people with diabetes, fibrates reduced the risk of albuminuria progression (relative risk [RR]: 0.86; 95% confidence interval [CI]: 0.76 to 0.98; p = 0.02). Serum creatinine was elevated by fibrate therapy (33 μmol/l, p < 0.001), calculated GFR was reduced (-2.67 ml/min/1.73 m(2), p = 0.01) but there was no detectable effect on the risk of end-stage kidney disease (RR: 0.85; 95% CI: 0.49 to 1.49; p = 0.575). In patients with eGFR of 30 to 59.9 ml/min/1.73 m(2), fibrates reduced the risk of major cardiovascular events (RR: 0.70; 95% CI: 0.54 to 0.89; p = 0.004) and cardiovascular death (RR: 0.60; 95% CI: 0.38 to 0.96; p = 0.03) but not all-cause mortality. There were no clear safety concerns specific to people with CKD but available data were limited.
Fibrates improve lipid profiles and prevent cardiovascular events in people with CKD. They reduce albuminuria and reversibly increase serum creatinine but the effects on major kidney outcomes remain unknown. These results suggest that fibrates have a place in reducing cardiovascular risk in people with mild-to-moderate CKD.
本系统评价和荟萃分析旨在确定在慢性肾脏病（CKD）患者中使用贝特类药物治疗的疗效和安全性。
贝特类药物在心血管风险升高的人群中产生适度的心血管益处。关于 CKD 患者中贝特类药物的临床益处和安全性的证据有限。
系统检索 MEDLINE、EMBASE 和 Cochrane 图书馆（1950 年至 2012 年 1 月），以评估比较 CKD 患者或与肾脏相关结局的贝特类药物治疗与安慰剂相比的前瞻性随机对照试验。
确定了 10 项研究，共纳入 16869 名参与者。在轻度至中度 CKD（估计肾小球滤过率[eGFR]≤60ml/min/1.73m²）患者中，贝特类药物可改善血脂谱（总胆固醇降低[-0.32mmol/l，p=0.05]和甘油三酯水平降低[-0.56mmol/l，p=0.03]，但低密度脂蛋白胆固醇降低[-0.01mmol/l，p=0.83]；高密度脂蛋白胆固醇升高[0.06mmol/l，p=0.001]）。在糖尿病患者中，贝特类药物降低了蛋白尿进展的风险（相对风险[RR]：0.86；95%置信区间[CI]：0.76 至 0.98；p=0.02）。血清肌酐升高（33μmol/l，p<0.001），估计肾小球滤过率降低（-2.67ml/min/1.73m²，p=0.01），但对终末期肾病的风险无明显影响（RR：0.85；95%CI：0.49 至 1.49；p=0.575）。在 eGFR 为 30 至 59.9ml/min/1.73m²的患者中，贝特类药物降低了主要心血管事件（RR：0.70；95%CI：0.54 至 0.89；p=0.004）和心血管死亡（RR：0.60；95%CI：0.38 至 0.96；p=0.03）的风险，但不能降低全因死亡率。CKD 患者无明确的具体安全性问题，但现有数据有限。
贝特类药物可改善 CKD 患者的血脂谱并预防心血管事件。它们可减少蛋白尿并可逆性地升高血清肌酐，但对主要肾脏结局的影响仍不清楚。这些结果表明，贝特类药物在降低轻度至中度 CKD 患者的心血管风险方面具有一定作用。
