Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Clin Endocrinol Metab. 2021 May 13;106(6):1594-1605. doi: 10.1210/clinem/dgab137.
Fenofibrate provides limited cardiovascular (CV) benefits in the general population; however, little is known about its benefit among advanced chronic kidney disease (CKD) patients.
This study compared outcomes among advanced CKD patients treated with fenofibrate, statins, a combination of both, and none of these.
This national cohort study was based on Taiwan's National Health Insurance Research Database. Patients younger than 20 years with advanced CKD were identified and further divided into 4 groups according to treatment. The inverse probability of treatment weighting was used to balance baseline characteristics. Patients received fenofibrate, statins, a combination of fenofibrate and statins, or none of these in the 3 months preceding the advanced CKD date. Main outcome measures included all-cause mortality, CV death, and incidence of permanent dialysis.
The fenofibrate and statin groups exhibited a lower risk of CV death (fenofibrate vs nonuser: hazard ratio [HR]: 0.84; 95% CI, 0.75-0.94; statins vs nonuser: HR: 0.94; 95% CI, 0.90-0.97) compared with the nonuser group. The fenofibrate group further exhibited the lowest incidence of permanent dialysis (fenofibrate vs nonuser: subdistribution HR [SHR]: 0.78; 95% CI, 0.77-0.80; statins vs fenofibrate: SHR: 1.27; 95% CI, 1.26-1.29; combination vs fenofibrate: SHR: 1.15; 95% CI, 1.13-1.17). Furthermore, the combined administration of fenofibrate and high-intensity statins exhibited a lower risk of major adverse cardiac and cerebrovascular events.
For patients with advanced CKD, continuing fenofibrate may provide a protective effect on CV outcomes equal to that of statins, and it may further delay the need for permanent dialysis. The combination of fenofibrate and high-intensity statins may have additional benefits.
非诺贝特在普通人群中对心血管（CV）的益处有限；然而，对于晚期慢性肾脏病（CKD）患者，其益处知之甚少。
本研究比较了接受非诺贝特、他汀类药物、两者联合治疗以及未接受治疗的晚期 CKD 患者的结局。
本全国性队列研究基于台湾全民健康保险研究数据库。确定年龄小于 20 岁的晚期 CKD 患者，并根据治疗方法将其进一步分为 4 组。采用逆概率治疗加权法平衡基线特征。在晚期 CKD 日期前的 3 个月内，患者接受非诺贝特、他汀类药物、非诺贝特和他汀类药物联合治疗或未接受任何治疗。主要结局指标包括全因死亡率、CV 死亡率和永久性透析发生率。
与非使用者相比，非诺贝特和他汀类药物组的 CV 死亡率较低（非诺贝特 vs 非使用者：风险比[HR]：0.84；95%CI，0.75-0.94；他汀类药物 vs 非使用者：HR：0.94；95%CI，0.90-0.97）。非诺贝特组进一步显示永久性透析发生率最低（非诺贝特 vs 非使用者：亚分布 HR[SHR]：0.78；95%CI，0.77-0.80；他汀类药物 vs 非诺贝特：SHR：1.27；95%CI，1.26-1.29；联合治疗 vs 非诺贝特：SHR：1.15；95%CI，1.13-1.17）。此外，联合应用非诺贝特和高强度他汀类药物可降低主要不良心脏和脑血管事件的风险。
对于晚期 CKD 患者，继续使用非诺贝特可能对 CV 结局的保护作用与他汀类药物相当，并可能进一步延迟永久性透析的需要。非诺贝特和高强度他汀类药物的联合应用可能具有额外的益处。
