Hadjivasilis Alexandros, Kouis Panayiotis, Kousios Andreas, Panayiotou Andrie
Cardiovascular Epidemiology and Genetics Research Lab, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3036, Cyprus.
Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia 1678, Cyprus.
J Clin Med. 2022 Jan 31;11(3):768. doi: 10.3390/jcm11030768.
Fibrates have proven efficacy in cardiovascular risk reduction and are commonly used, in addition to statins, to control hypertriglyceridaemia. Their use is often limited due to reduction in glomerular filtration rate at treatment initiation. However, recent studies suggest benign changes in kidney function and improvement of proteinuria, an established early marker of microvascular disease and kidney disease progression. We summarize the evidence from existing trials and provide a summary of effects of fibrates, alone or in combination, on kidney disease progression and proteinuria.
Systematic review and meta-analysis of randomized, controlled trials (PROSPERO CRD42020187764). Out of 12,243 potentially eligible studies, 29 were included in qualitative and quantitative analysis, with a total of 20,176 patients. Mean creatinine increased by 1.05 (95% CI (0.63 to 1.46)) units in patients receiving fibrates vs. comparator, and this was similar in all other subgroups. eGFR showed a bigger decrease in the fibrates arm (SMD -1.99; 95% CI (-3.49 to -0.48)) when all studies were pooled together. Notably, short-term serum creatinine and eGFR changes remained constant in the long-term. Pooled estimates show that fibrates improve albuminuria progression, RR 0.86; 95% CI (0.76 to 0.98); albuminuria regression, RR 1.19; 95% CI (1.08 to 1.310).
Fibrates improve albuminuria in patients with and without diabetes when used to treat hyperlipidaemia. The modest creatinine increase should not be a limiting factor for fibrate initiation in people with preserved renal function or mild CKD. The long-term effects on kidney disease progression warrant further study.
贝特类药物已被证明在降低心血管风险方面有效，并且除他汀类药物外，常用于控制高甘油三酯血症。由于治疗开始时肾小球滤过率降低，其应用常常受到限制。然而，最近的研究表明，肾功能有良性变化，蛋白尿得到改善，蛋白尿是微血管疾病和肾脏疾病进展的既定早期标志物。我们总结了现有试验的证据，并概述了贝特类药物单独或联合使用对肾脏疾病进展和蛋白尿的影响。
对随机对照试验进行系统评价和荟萃分析（国际前瞻性系统评价注册库CRD42020187764）。在12243项可能符合条件的研究中，29项纳入定性和定量分析，共有20176例患者。接受贝特类药物治疗的患者与对照相比，平均肌酐升高1.05（95%CI（0.63至1.46））个单位，在所有其他亚组中情况相似。当汇总所有研究时，估计肾小球滤过率（eGFR）在贝特类药物组下降幅度更大（标准化均数差-1.99；95%CI（-3.49至-0.48））。值得注意的是，短期血清肌酐和eGFR变化在长期内保持不变。汇总估计显示，贝特类药物可改善蛋白尿进展，风险比（RR）为0.86；95%CI（0.76至0.98）；蛋白尿消退，RR为1.19；95%CI（1.08至1.310）。
贝特类药物用于治疗高脂血症时，可改善糖尿病和非糖尿病患者的蛋白尿。肌酐适度升高不应成为肾功能正常或轻度慢性肾脏病患者开始使用贝特类药物的限制因素。其对肾脏疾病进展的长期影响值得进一步研究。
